Multi-level executive functioning tasks

ABSTRACT

Systems and methods of the present invention provide for generating a first, second, and third series of interface objects comprising a first and second sequence respectively, displayed on a graphical user interface (GUI). At least one visual indicator display object is also displayed that requires a switch between the first and second series of user interface objects. A user navigates through the first and second series of interface objects, including the visual indicator display object(s), and a score for the user is calculated according to a user input matching, or failing to match, a correct response associated with a task data defining a function skill demonstrating a cognitive ability of the user.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

This patent application is a continuation-in-part of, and claimspriority to, U.S. patent application Ser. No. 15/599,050 filed May 18,2017 and titled “MULTI-LEVEL EXECUTIVE FUNCTIONING TASKS.”

FIELD OF THE INVENTION

This disclosure relates to the field of systems and methods configuredto administer executive functioning tests, subtests, and tasks andanalyzing input from a client machine in order to detect a cognitivedecline, possibly caused by neurological or psychiatric insult, andpossibly detecting early stage disease, and specifically to executesoftware logic within the systems in order to administer the tests,subtests, and tasks in order to generate results and evaluate examineesvia the disclosed system.

SUMMARY OF THE INVENTION

The present invention provides systems and methods comprising one ormore server hardware computing devices or client hardware computingdevices, communicatively coupled to a network, and each comprising atleast one processor executing specific computer-executable instructionswithin a memory that, when executed, cause the system to: generate afirst, second, and third series of interface objects comprising a firstand second sequence respectively, displayed on a graphical userinterface (GUI). At least one visual indicator display object is alsodisplayed that requires a switch between the first and second series ofuser interface objects. A user navigates through the first and secondseries of interface objects, including the visual indicator displayobject(s), and a score for the user is calculated according to a userinput matching, or failing to match, a correct response associated witha task data defining a function skill demonstrating a cognitive abilityof the user.

The above features and advantages of the present invention will bebetter understood from the following detailed description taken inconjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a system level block diagram for administering andscoring multiple level executive functioning tests and tasks.

FIG. 2 illustrates a system level block diagram for administering andscoring multiple level executive functioning tests and tasks.

FIG. 3 illustrates a system level block diagram for administering andscoring multiple level executive functioning tests and tasks.

FIG. 4 illustrates a flow diagram for administering and scoring multiplelevel executive functioning tests and tasks.

FIG. 5 illustrates a flow diagram for administering and scoring multiplelevel executive functioning tests and tasks.

FIG. 6 illustrates a flow diagram for administering and scoring multiplelevel executive functioning tests and tasks.

FIG. 7 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 8 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 9 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 10 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 11 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 12 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 13 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 14 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 15 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 16 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 17 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 18 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

FIG. 19 illustrates an example user interface for administering andscoring multiple level executive functioning tests and tasks.

DETAILED DESCRIPTION

The present inventions will now be discussed in detail with regard tothe attached drawing figures that were briefly described above. In thefollowing description, numerous specific details are set forthillustrating the Applicant's best mode for practicing the invention andenabling one of ordinary skill in the art to make and use the invention.It will be obvious, however, to one skilled in the art that the presentinvention may be practiced without many of these specific details. Inother instances, well-known machines, structures, and method steps havenot been described in particular detail in order to avoid unnecessarilyobscuring the present invention. Unless otherwise indicated, like partsand method steps are referred to with like reference numerals.

Declines in higher-level cognitive skills, commonly referred to asexecutive functions, are frequently one of the earliest signs ofcognitive decline following a neurological or psychiatric insult orearly in a disease process. However, in high-ability individuals, suchdecline is often difficult to detect early due to an individual's higherceiling in most executive function measures. Many existing tasksassessing executive function are easily passed by individuals withhigher ability, even when the individuals are impaired.

The present disclosures provides a system including a server computerconfigured to execute software logic within one or more testing softwaremodules to generate and display, on one or more client machines (e.g.,an examiner and examinee client device, described below), one or moretasks requiring user input responding to one or more decision pointsdisplayed on the client device and generated in association with thetesting software modules.

The server computer may receive and automatically evaluate the userinput, according to a plurality of data records stored in a databasedefining correct and incorrect responses, and the logic within the oneor more testing software modules. Using the logic and data records, theserver computer may generate a score for each test, wherein higherscores are determined according to a greater number of matches betweenthe user input and the correct data records and logic, and lower scoresare determined according to a lower number of matches between the userinput and the correct data records and logic.

Thus, the disclosed system provides a new systematic assessment ofexecutive functioning skills paradigms, based on a Delis-KaplanExecutive Functioning System (D-KEFS) test. The D-KEFS test has promiseto detect and follow individuals at risk for cognitive decline followinghead trauma or neurological insult. It is non-invasive and inexpensiverelative to positron emission tomography (PET) imaging, magneticresonance imaging (MRI), and other current methods that are in intensedevelopment.

The disclosed embodiments of the D-KEFS assessment methodology providesa systematic assessment of individual executive functioning skills(e.g., those with head trauma). In addition to individual skillassessments, the disclosed embodiments may include single tasks thatintroduce multiple executive functions which the examinee must usesimultaneously in order to complete the task correctly, thereby creatinga higher-level condition to assess executive functioning by increasingthe executive function load for examinees taking the D-KEFS test. Insome embodiments, each added executive function may require a greaterexecutive function load than the preceding task.

This allows assessment of individuals with higher ability, which mayotherwise have passed the tasks including only individual executivefunctioning skills. That is, the addition of more difficult measuresincreases the sensitivity in higher-ability individuals. For example, inthe trail making tests described herein, an examinee identifies and/orconnects letters or numbers sequentially, or alternates between lettersand numbers sequentially. In addition to this single task, examinees maybe simultaneously required to change the pattern based on visual cuessuch as boxes around the letters or numbers, ignore additionaldistractions such as flashing graphics, and/or may be required tocomplete the task without the aid of visual feedback. Any combinationsof these tasks may thereby increase the sensitivity of the assessmentfor individuals with higher abilities on task completion. This allowsfor earlier intervention or detection of decline at a time whenintervention has a greater potential for slowing down a neurologicalinsult or disease process.

Thus, the disclosed embodiments provide a systematic assessment ofexecutive functioning skills. However, the testing environments may beperceived as sterile and may not represent daily life distractions(e.g., by administering neuropsychological tests in distraction-free,quiet, and controlled environments). In these sterile testingenvironments, individuals with higher abilities may easily pass existingtasks for assessing executive function, even when they are impaired(e.g., individuals having some brain injuries).

Clinicians, and other testing organizations, may also desire todetermine whether individuals in testing situations are highlydistractible in such testing accommodations and other testing situations(e.g., high stakes testing, such as the bar exam, the GRE, the SAT,etc.). The disclosed embodiments may therefore be used to determinewhether or not a person is particularly distractible.

The distraction tasks in the disclosed embodiments build upon thepreviously tests disclosed below, creating a more ecologically-validcondition to assess executive functioning in an environment more similarto real-life settings and allow for more refined assessment ofindividuals with higher ability, the ecological validity of the testsgeneralizing to real world situations, as distractions are common inreal-world settings. The additional requirement of completing the taskwhile hearing and seeing alternate distracting stimuli will thereforeincrease the sensitivity of the assessment to individuals with higherabilities.

The distraction tasks may introduce stimuli that compete with theoriginal task, to distract an examinee from accurately completing thetask. The goal of the distraction is to make the examinee thinkincorrectly, thereby causing them to be distracted from the originalobjective within the task. Although simple auditory distraction orvisual stimuli may be effective alone, the combination of visual andauditory distraction together, highly related to the task that the useris completing, produces a much higher effect, as shown in the disclosedembodiments.

Thus, as shown herein, the task may include both audio and visualdistraction. For example, in the trail distraction tests disclosedbelow, an examinee may be required to conduct a series of tasksswitching between numbers and letters, connecting dots in consecutiveorder while switching between a number sequence and a letter sequence(i.e., 1, A, 2, B, and so on). While the examinee is conducting thetasks, non-random distractions may be introduced, including auditorysounds and/or visual stimuli designed to mislead the examinee. Forexample, when a correct answer is the number 3 (which the examineeshould select), they may hear the letter C being read aloud, which isalso displayed on their testing screen, and so forth.

These distractors may also affect the time required to complete thetasks within the instructions. Thus, the distractors both slows down theuser, and may cause them to make the wrong choice. The more generaltests outlined herein may therefore be administered first, and thenagain with the distraction tasks added to the assessment. By using thesame scoring rubric (described in detail below) the differences betweenthe original test and the test with distractions may be analyzed, whichmay, in turn, create a more focused identification of the reason for thecognitive decline following head trauma or neurological insult, forexample.

FIG. 1 illustrates a non-limiting example distributed computingenvironment 100, which includes one or more computer server computingdevices 102, one or more client computing devices 106, and othercomponents that may implement certain embodiments and features describedherein. Other devices, such as specialized sensor devices, etc., mayinteract with client 106 and/or server 102. The server 102, client 106,or any other devices may be configured to implement a client-servermodel or any other distributed computing architecture.

Server 102, client 106, and any other disclosed devices may becommunicatively coupled via one or more communication networks 120.Communication network 120 may be any type of network known in the artsupporting data communications. As non-limiting examples, network 120may be a local area network (LAN; e.g., Ethernet, Token-Ring, etc.), awide-area network (e.g., the Internet), an infrared or wireless network,a public switched telephone networks (PSTNs), a virtual network, etc.Network 120 may use any available protocols, such as (e.g., transmissioncontrol protocol/Internet protocol (TCP/IP), systems networkarchitecture (SNA), Internet packet exchange (IPX), Secure Sockets Layer(SSL), Transport Layer Security (TLS), Hypertext Transfer Protocol(HTTP), Secure Hypertext Transfer Protocol (HTTPS), Institute ofElectrical and Electronics (IEEE) 802.11 protocol suite or otherwireless protocols, and the like.

The embodiments shown in FIGS. 1-2 are thus one example of a distributedcomputing system and is not intended to be limiting. The subsystems andcomponents within the server 102 and client devices 106 may beimplemented in hardware, firmware, software, or combinations thereof.Various different subsystems and/or components 104 may be implemented onserver 202. Users operating the client devices 106 may initiate one ormore client applications to use services provided by these subsystemsand components. Various different system configurations are possible indifferent distributed computing systems 100 and content distributionnetworks. Server 102 may be configured to run one or more serversoftware applications or services, for example, web-based or cloud-basedservices, to support content distribution and interaction with clientdevices 106. Users operating client devices 106 may in turn utilize oneor more client applications (e.g., virtual client applications) tointeract with server 102 to utilize the services provided by thesecomponents. Client devices 106 may be configured to receive and executeclient applications over one or more networks 120. Such clientapplications may be web browser based applications and/or standalonesoftware applications, such as mobile device applications. Clientdevices 106 may receive client applications from server 102 or fromother application providers (e.g., public or private applicationstores).

As shown in FIG. 1, various security and integration components 108 maybe used to manage communications over network 120 (e.g., a file-basedintegration scheme or a service-based integration scheme). Security andintegration components 108 may implement various security features fordata transmission and storage, such as authenticating users orrestricting access to unknown or unauthorized users,

As non-limiting examples, these security components 108 may comprisededicated hardware, specialized networking components, and/or software(e.g., web servers, authentication servers, firewalls, routers,gateways, load balancers, etc.) within one or more data centers in oneor more physical location and/or operated by one or more entities,and/or may be operated within a cloud infrastructure.

In various implementations, security and integration components 108 maytransmit data between the various devices in the content distributionnetwork 100. Security and integration components 108 also may use securedata transmission protocols and/or encryption (e.g., File TransferProtocol (FTP), Secure File Transfer Protocol (SFTP), and/or Pretty GoodPrivacy (PGP) encryption) for data transfers, etc.).

In some embodiments, the security and integration components 108 mayimplement one or more web services (e.g., cross-domain and/orcross-platform web services) within the content distribution network100, and may be developed for enterprise use in accordance with variousweb service standards (e.g., the Web Service Interoperability (WS-I)guidelines). For example, some web services may provide secureconnections, authentication, and/or confidentiality throughout thenetwork using technologies such as SSL, TLS, HTTP, HTTPS, WS-Securitystandard (providing secure SOAP messages using XML encryption), etc. Inother examples, the security and integration components 108 may includespecialized hardware, network appliances, and the like (e.g.,hardware-accelerated SSL and HTTPS), possibly installed and configuredbetween servers 102 and other network components, for providing secureweb services, thereby allowing any external devices to communicatedirectly with the specialized hardware, network appliances, etc.

Computing environment 100 also may include one or more data stores 110,possibly including and/or residing on one or more back-end servers 112,operating in one or more data centers in one or more physical locations,and communicating with one or more other devices within one or morenetworks 120. In some cases, one or more data stores 110 may reside on anon-transitory storage medium within the server 102. In certainembodiments, data stores 110 and back-end servers 112 may reside in astorage-area network (SAN). Access to the data stores may be limited ordenied based on the processes, user credentials, and/or devicesattempting to interact with the data store.

With reference now to FIG. 2, a block diagram of an illustrativecomputer system is shown. The system 200 may correspond to any of thecomputing devices or servers of the network 100, or any other computingdevices described herein. In this example, computer system 200 includesprocessing units 204 that communicate with a number of peripheralsubsystems via a bus subsystem 502. These peripheral subsystems include,for example, a storage subsystem 210, an I/O subsystem 226, and acommunications subsystem 232.

One or more processing units 204 may be implemented as one or moreintegrated circuits (e.g., a conventional micro-processor ormicrocontroller), and controls the operation of computer system 200.These processors may include single core and/or multicore (e.g., quadcore, hexa-core, octo-core, ten-core, etc.) processors and processorcaches. These processors 204 may execute a variety of resident softwareprocesses embodied in program code, and may maintain multipleconcurrently executing programs or processes. Processor(s) 204 may alsoinclude one or more specialized processors, (e.g., digital signalprocessors (DSPs), outboard, graphics application-specific, and/or otherprocessors).

Bus subsystem 202 provides a mechanism for intended communicationbetween the various components and subsystems of computer system 200.Although bus subsystem 202 is shown schematically as a single bus,alternative embodiments of the bus subsystem may utilize multiple buses.Bus subsystem 202 may include a memory bus, memory controller,peripheral bus, and/or local bus using any of a variety of busarchitectures (e.g. Industry Standard Architecture (ISA), Micro ChannelArchitecture (MCA), Enhanced ISA (EISA), Video Electronics StandardsAssociation (VESA), and/or Peripheral Component Interconnect (PCI) bus,possibly implemented as a Mezzanine bus manufactured to the IEEE P1386.1standard).

I/O subsystem 226 may include device controllers 228 for one or moreuser interface input devices and/or user interface output devices,possibly integrated with the computer system 200 (e.g., integratedaudio/video systems, and/or touchscreen displays), or may be separateperipheral devices which are attachable/detachable from the computersystem 200. Input may include keyboard or mouse input, audio input(e.g., spoken commands), motion sensing, gesture recognition (e.g., eyegestures), etc.

As non-limiting examples, input devices may include a keyboard, pointingdevices (e.g., mouse, trackball, and associated input), touchpads, touchscreens, scroll wheels, click wheels, dials, buttons, switches, keypad,audio input devices, voice command recognition systems, microphones,three dimensional (3D) mice, joysticks, pointing sticks, gamepads,graphic tablets, speakers, digital cameras, digital camcorders, portablemedia players, webcams, image scanners, fingerprint scanners, barcodereaders, 3D scanners, 3D printers, laser rangefinders, eye gaze trackingdevices, medical imaging input devices, MIDI keyboards, digital musicalinstruments, and the like.

In general, use of the term “output device” is intended to include allpossible types of devices and mechanisms for outputting information fromcomputer system 200 to a user or other computer. For example, outputdevices may include one or more display subsystems and/or displaydevices that visually convey text, graphics and audio/video information(e.g., cathode ray tube (CRT) displays, flat-panel devices, liquidcrystal display (LCD) or plasma display devices, projection devices,touch screens, etc.), and/or non-visual displays such as audio outputdevices, etc. As non-limiting examples, output devices may include,indicator lights, monitors, printers, speakers, headphones, automotivenavigation systems, plotters, voice output devices, modems, etc.

Computer system 200 may comprise one or more storage subsystems 210,comprising hardware and software components used for storing data andprogram instructions, such as system memory 218 and computer-readablestorage media 216.

System memory 218 and/or computer-readable storage media 616 may storeprogram instructions that are loadable and executable on processor(s)204. For example, system memory 218 may load and execute an operatingsystem 224, program data 222, server applications, client applications,Internet browsers, mid-tier applications, etc.

System memory may further store data generated during execution of theseinstructions. System memory 218 may be stored in volatile memory (e.g.,random access memory (RAM) 212, including static random access memory(SRAM) or dynamic random access memory (DRAM)). RAM 212 may contain dataand/or program modules that are immediately accessible to and/oroperated and executed by processing units 504.

System memory 218 may also be stored in non-volatile storage drives 214(e.g., read-only memory (ROM), flash memory, etc.) For example, a basicinput/output system (BIOS), containing the basic routines that help totransfer information between elements within computer system 200 (e.g.,during start-up) may typically be stored in the non-volatile storagedrives 214.

Storage subsystem 210 also may include one or more tangiblecomputer-readable storage media 216 for storing the basic programmingand data constructs that provide the functionality of some embodiments.For example, storage subsystem 210 may include software, programs, codemodules, instructions, etc., that may be executed by a processor 204, inorder to provide the functionality described herein. Data generated fromthe executed software, programs, code, modules, or instructions may bestored within a data storage repository within storage subsystem 210.

Storage subsystem 200 may also include a computer-readable storage mediareader connected to computer-readable storage media 216.Computer-readable storage media 216 may contain program code, orportions of program code. Together and, optionally, in combination withsystem memory 218, computer-readable storage media 216 maycomprehensively represent remote, local, fixed, and/or removable storagedevices plus storage media for temporarily and/or more permanentlycontaining, storing, transmitting, and retrieving computer-readableinformation.

Computer-readable storage media 216 may include any appropriate mediaknown or used in the art, including storage media and communicationmedia, such as but not limited to, volatile and non-volatile, removableand non-removable media implemented in any method or technology forstorage and/or transmission of information. This can include tangiblecomputer-readable storage media such as RAM, ROM, electronicallyerasable programmable ROM (EEPROM), flash memory or other memorytechnology, CD-ROM, digital versatile disk (DVD), or other opticalstorage, magnetic cassettes, magnetic tape, magnetic disk storage orother magnetic storage devices, or other tangible computer readablemedia. This can also include nontangible computer-readable media, suchas data signals, data transmissions, or any other medium which can beused to transmit the desired information and which can be accessed bycomputer system 200.

By way of example, computer-readable storage media 216 may include ahard disk drive that reads from or writes to non-removable, nonvolatilemagnetic media, a magnetic disk drive that reads from or writes to aremovable, nonvolatile magnetic disk, and an optical disk drive thatreads from or writes to a removable, nonvolatile optical disk such as aCD ROM, DVD, and Blu-Ray® disk, or other optical media.Computer-readable storage media 216 may include, but is not limited to,Zip® drives, flash memory cards, universal serial bus (USB) flashdrives, secure digital (SD) cards, DVD disks, digital video tape, andthe like. Computer-readable storage media 216 may also include,solid-state drives (SSD) based on non-volatile memory such asflash-memory based SSDs, enterprise flash drives, solid state ROM, andthe like, SSDs based on volatile memory such as solid state RAM, dynamicRAM, static RAM, DRAM-based SSDs, magneto-resistive RAM (MRAM) SSDs, andhybrid SSDs that use a combination of DRAM and flash memory based SSDs.The disk drives and their associated computer-readable media may providenon-volatile storage of computer-readable instructions, data structures,program modules, and other data for computer system 200.

Communications subsystem 232 may provide a communication interface fromcomputer system 500 and external computing devices via one or morecommunication networks, including local area networks (LANs), wide areanetworks (WANs) (e.g., the Internet), and various wirelesstelecommunications networks. As illustrated in FIG. 2, thecommunications subsystem 232 may include, for example, one or morenetwork interface controllers (NICs) 234, such as Ethernet cards,Asynchronous Transfer Mode NICs, Token Ring NICs, and the like, as wellas one or more wireless communications interfaces 236, such as wirelessnetwork interface controllers (WNICs), wireless network adapters, andthe like. Additionally and/or alternatively, the communicationssubsystem 232 may include one or more modems (telephone, satellite,cable, ISDN), synchronous or asynchronous digital subscriber line (DSL)units, Fire Wire® interfaces, USB® interfaces, and the like.Communications subsystem 236 also may include radio frequency (RF)transceiver components for accessing wireless voice and/or data networks(e.g., using cellular telephone technology, advanced data networktechnology, such as 3G, 4G or EDGE (enhanced data rates for globalevolution), WiFi (IEEE 802.11 family standards, or other mobilecommunication technologies, or any combination thereof), globalpositioning system (GPS) receiver components, and/or other components.

In some embodiments, communications subsystem 232 may also receive inputcommunication in the form of structured and/or unstructured data feeds,event streams, event updates, and the like, on behalf of one or moreusers who may use or access computer system 200. For example,communications subsystem 232 may be configured to receive data feeds inreal-time from users of social networks and/or other communicationservices, web feeds such as Rich Site Summary (RSS) feeds, and/orreal-time updates from one or more third party information sources(e.g., data aggregators). Additionally, communications subsystem 232 maybe configured to receive data in the form of continuous data streams,which may include event streams of real-time events and/or event updates(e.g., sensor data applications, financial tickers, network performancemeasuring tools, clickstream analysis tools, automobile trafficmonitoring, etc.). Communications subsystem 232 may output suchstructured and/or unstructured data feeds, event streams, event updates,and the like to one or more data stores that may be in communicationwith one or more streaming data source computers coupled to computersystem 200.

The various physical components of the communications subsystem 232 maybe detachable components coupled to the computer system 200 via acomputer network, a FireWire® bus, or the like, and/or may be physicallyintegrated onto a motherboard of the computer system 200. Communicationssubsystem 232 also may be implemented in whole or in part by software.

Due to the ever-changing nature of computers and networks, thedescription of computer system 200 depicted in the figure is intendedonly as a specific example. Many other configurations having more orfewer components than the system depicted in the figure are possible.For example, customized hardware might also be used and/or particularelements might be implemented in hardware, firmware, software, or acombination. Further, connection to other computing devices, such asnetwork input/output devices, may be employed. Based on the disclosureand teachings provided herein, a person of ordinary skill in the artwill appreciate other ways and/or methods to implement the variousembodiments.

FIG. 3 shows a hardware and software environment in accordance with thepresent disclosure in which the disclosed tests may be given and theresults calculated. One or more entities may operate one or more serverhardware computing devices (server 102) in one or more data centers.Each server 102 may include one or more processors executing specificcomputer-executable instructions within a memory coupled to each server102 and display the tests, subtests, and/or tasks themselves, as well asthe results of the tests, to the administrator (examiner), and/or theuser, test subject and/or patient (examinee). Thus, server 102 mayinclude a computer or program that provides services to other computers,programs, or users over a computer network.

As noted above, the computer-executable instructions may be containedwithin one or more software modules. The disclosed embodiments do notlimit the hardware computing devices that may run and execute suchsoftware and/or the computer-executable instructions within memory. Forexample, the software instructions may be run and executed on anycombination of servers 102, and/or client hardware computing devices(clients 106). It should be understood, therefore, that although thedisclosed embodiments refer to instructions, logic, and/or softwaremodules being executed by server 102, the disclosed method steps may beexecuted by any combination of servers 102 and clients 106.

The disclosed embodiments may also include one or more data stores 110.Servers 102, clients 106 and data storage 110 may all be coupled vianetwork 120. Data storage 110 may include any combination of contentstorage, databases, data tables, data records, and/or data fieldsstoring data associated with the disclosed embodiments. These examplesare non-limiting. For example, data storage 110 may be a relational ornon-structured database, and/or may include any electronic documentcapable of storing data for a period of time, such as a spreadsheet,flat file, XML file, etc.

The software modules containing the algorithms, instructions, logic,etc. may execute the method steps disclosed herein, and in somedisclosed embodiments, may be performed automatically without humaninteraction. As seen in FIG. 1, the disclosed environment may includeone or more clients 106, and the one or more software modules may run onthe server 102 or clients 106, which may include any computer or programthat provides services to other computers, programs, or users either inthe same computer or over a computer network 120. As non-limitingexamples, the client 106 may include a laptop computer, a desktopcomputer or a mobile device, such as a mobile phone or a tabletcomputing device, which may connect wirelessly to the network 120.

In some embodiments, a first GUI may be provided for an examineradministrating a test, and a second GUI may be provided for an examineetaking the test. In these embodiments, both the examiner and examineemay each operate a client 106 (e.g., Client 1, Examiner client; Clientn, Examinee Client), such as a tablet operated using a touch screenand/or a stylus. In these embodiments, seen in FIGS. 8, 9, and 11, anexaminer GUI may include an electronic output providing the user withinstructions for the exam, a first GUI control for monitoring theelectronic input received from the user, and/or a second GUI control fordemonstrating a correct response and an incorrect response to a prompt,as non-limiting examples.

The disclosed clients 106 may include GUIs allowing the examinee tointeract with the tests and to display the results of the tests to theexaminer and examinee. These GUIs may include graphical, textual,scanned and/or auditory information a computer program presents to theuser, and the control sequences such as keystrokes, movements of thecomputer mouse, selections with a touch screen, scanned information etc.used to control the program. The commands received within the softwaremodules, or other data, may be accepted using a field, widget and/or GUIcontrol used in such interfaces, including but not limited to atext-box, text field, button, hyper-link, list, drop-down list,check-box, radio button, data grid, icon, graphical image, embeddedlink, etc.

In some configurations, the client 106 may receive input from anexaminee. As non-limiting examples, this input may be used for theexaminer or examinee to select a test, subtest, and/or task, for theexaminee to acknowledge receipt of instructions, for an examiner orexaminee to begin a practice or actual test, subtest, and/or task, foran examiner to pause a test and demonstrate errors or correct responses(e.g., identify correct or incorrect examinee responses or input duringthe test), for an examiner to stop an exam after a designated timeperiod, etc., as disclosed in more detail below.

In some configurations, the input received by the client may be used torun calculations via a combination of server 102 and/or client(s) 106.For example, in administered tests described below, the test may bedisplayed, and the examinee's responses may be received via the client106, but the display may be generated, the examinee's responsesreceived, and the calculations to determine the results run on one ormore servers 102 at a location remote from the client 106.

Software modules on server(s) 102 and/or client 106 may identify one ormore data records within database 110 associated with tests, subtestsand/or tasks selected by an examiner or examinee. Structurally, thedatabase 110 may include a collection of data, and this data may bestored for a length of time, for example, with a secure server in thecloud, providing access to the generated data as desired.

As non-limiting examples, associated data records may include datarecords containing algorithms, rules, calculations, textual ormultimedia (e.g., image or audio) data needed for: instructionsdisplayed on client 106 and/or read by the examiner for practice testsor conditions; images, numbers, letters, boxes, colors, layout, etc.necessary for practice and/or actual tests and/or tasks; GUI controls,images, characters or character strings, etc. for practice or actualtests and/or tasks; timers for both practice and actual tests and/ortasks; type of incorrect response (e.g., sequencing or set loss errors);mapping (e.g., sequences, layout, connecting lines, etc.) for correctand incorrect answers at each decision point within example and actualtests and/or tasks; responses and/or notifications to be displayed toexaminees upon correct and incorrect input; scoring paradigms for eachtest and/or task; actual user scores according to the scoring paradigms;one or more cognitive declines, neurological insults, and/or early stagediseases; an association between the one or more cognitive declines,neurological insults and/or early stage diseases, a predeterminedthreshold, and one or more of the user scores below which each cognitivedecline, neurological insult and early stage disease may be identified;etc.

For each test, software modules on server 102 and/or client 106 maygenerate a GUI display (e.g., a web page or a client application GUI),for authenticating the examiner and/or the examinee. This GUI may bedisplayed on the client computer(s) 106 (e.g., the examiner and/orexaminee's tablet computer). The examiner and/or examinee may beauthenticated to the disclosed software modules, possibly using ausername and password created by the examiner and/or examinee inassociation with an examiner and/or examinee account stored in database110. Data for the examiner and/or examinee account may include, asnon-limiting examples, the username and password, and in someembodiments, data regarding the cognitive functions being tested,examinee history (e.g., previous test scores, reason for test, etc.),tests that the examiner has deemed prudent to be administered to theexaminee, etc.

Turning now to FIGS. 4-17, the disclosed D-KEFS test may include abattery of subtests (e.g., 9 subtests each with 1 or more tasks, alsoreferred to as conditions or trials), each of which may be associated inthe database 110 with a function skill used to demonstrate a cognitiveability of an examinee. These cognitive abilities within the tasks andfunction skills may be scored to determine the user's ability to respondto various instructions, and the resulting scores may be used toidentify a user's cognitive decline, neurological insult, early stagedisease, etc.

In some configurations, an examinee may be a test subject that is partof a clinical trial. The disclosed system may be part of an initialscreen at the sites administering the clinical trial. In theseconfigurations, the examiners (e.g., clinicians and/or doctors) may bescreening the subject for declines in executive functions, one of theearliest signs of cognitive decline following a neurological insult orearly in a disease process. The examinee may come to the testing siteand interact with a computer, mobile device, etc. in an environmentcontrolled by the examiner.

The 9 subtests, as well as their tasks are described in detail below,and may include, as non-limiting examples: Trail Making, Verbal Fluency,Design Fluency, Color Word Interference, Tower, Social Sorting, Derby,Prosody Word Interference, and Grocery List.

As noted above, each of the tests, subtests and/or tasks may beassociated with a function skill used to demonstrate the cognitiveability of the examinee. In the subtests and tasks described below,these function skills may include a list of function skills within anexecutive function domain. Database 110 may store a plurality of taskdata for each executive function domain, and each executive functiondomain name may be further associated with and represent a functionskill demonstrating a cognitive ability of the user.

As non-limiting examples, the executive function domains may include:Cognitive/Behavioral Control, Planning, Cognitive Flexibility (which mayinclude a dual-level, triple-level, or other multi-level switchingtask), Inhibitory Control, Self-Monitoring, Rule Violations, BehavioralProductivity (Initiation), Risk-Taking Control, Affect Perception, andEmotion Regulation, each of which will be described as associated withthe tasks described in greater detail below.

Examples of these types of tasks are as follows: (a) dual-level task:the Inhibition/Switching Condition of the Color-Word Interference Test;(b) triple-level task: the Switching/Distraction condition of theColor-Word Interference Test or the Complex Switching Condition of theTrail Making Test; (c) Cognitive/Behavioral Control: the Derby Test; (d)Cognitive Flexibility: all switching conditions of the Trail MakingTest, Color-Word Interference Test, Design Fluency Test, Verbal FluencyTest, Prosody-Word Interference Test, and Social Sorting Test; (e)Inhibitory Control: The Color-Word Interference Test and theProsody-Word Interference Test; (f) Self-Monitoring (all tests); (g)Rule Violations: all tests except for The Derby Test; (h) BehavioralProductivity (Initiation): all conditions of the Design Fluency Test,the Verbal Fluency Test, and the Tower Test; (i) Risk Taking Control:The Derby Test; (j) Affect Perception: the Social Sorting Test andProsody-Word Interference Test; and (k) Emotional Regulation (The DerbyTest and Social Sorting Test).

To administer the various subtests and tasks, server 102 mayauthenticate each examiner and/or examinee, and may further render andtransmit, for display on the examiner or examinee's client 106, a GUI(not shown) for selecting at least one of the subtests and/or tasks forthe examinee. Upon receiving the selection, one or more software moduleson server 102 may identify and select all data records in database 110associated with the selected task (e.g., by identifying a uniqueidentifier within all related data records for the selected task). Thesoftware modules may then analyze the data stored within the datarecords, including any data, logic, instructions, rules, content,correct or incorrect answers, scoring data, etc., relevant to theselected test as disclosed above.

Server 102 may then render/generate one or more GUIs displaying theselected subtest and/or task content. The one or more GUIs may encodeany combination of: a first series of user interface objects comprisinga first sequence or a plurality of character string descriptions; asecond series of user interface objects comprising a second sequence ora plurality of user interface characteristics; and at least one visualindicator display object requiring a switch between the first series ofuser interface objects, and the second series of user interface objects;

In the non-limiting examples seen in FIGS. 11, 12, and 14, server 102may render two separate GUIs, one for the examiner and one for theexaminee. For example the examiner or examinee GUI may be displayed onthe examiner client 106 (Client 1, e.g., a touch sensitive tablet usinga stylus) or examinee client 106 (Client n, a second touch sensitivetablet using a stylus) respectively.

The non-limiting-example examiner GUIs in FIGS. 11, 12, and 14demonstrate that the examiner GUI may render instruction data associatedwith the selected subtest and/or task, possibly including instructionsto be read and conveyed to the examinee regarding how the test is to beadministered. In embodiments where the examinee is using a singletablet, this instruction data, as well as the displayed correction datadescribed below, may be displayed or otherwise presented to the examinee(e.g., via display on a display screen or through audio instruction froman audio file, etc.). As a non-limiting example, the instruction datamay include data indicating a timer for each practice or actual test ortask, and the instructions may direct examinees to work as fast as theycan within these time constraints without making mistakes. The examineemay acknowledge (possibly via the examinee GUI) that the instructionsare understood, and in response, server 102 may select the data recordsassociated in the database with a practice test (e.g., graphics, text,correct/incorrect responses, notifications, examples, etc.), and maygenerate and render a practice test GUI used to acclimate the examineeto the timing and tasks of the subtest.

After receiving and reviewing the instruction for the practice test, theexaminee may enter a user input indicating that the instructions areunderstood and the practice test should begin. The timer may then bestarted, either at the conclusion of the instructions, or when theexaminee acknowledges the instructions to begin. As non-limitingexamples, the timer may include any range from 15 to 210 seconds, thoughother timer ranges are contemplated. Regarding the timer, the softwaremodules may compare the examinee's elapsed time with the timer datastored in database 110 for the subtest/task. If the elapsed time isgreater than the timer data for the test or task, the software modulesmay automatically terminate the practice test, or generate an alert thatthe elapsed time is greater than the timer data.

Client 106 may receive and decode task input (e.g., examinee responsesto the task conditions) from the examinee client 106, as input by theexaminee. This user input may be forwarded to and utilized by thealgorithms disclosed herein for calculating and displaying the resultsof the user input, in real time, and/or may be stored within thedatabase 110, possibly as one or more data records associated with theexaminee.

Each practice test and actual test may include various errors. Asnon-limiting examples, such errors may include sequencing errors or setloss errors. Sequencing errors may include, as non-limiting examples, auser touching or creating a path between objects in the incorrect order(e.g., touching or drawing a line between 1 and 3 instead of 1 and 2).Set loss errors may include errors where data is missing (e.g., userdoes not respond to a prompt in an appropriate manner).

In some embodiments, the system may generate prompts during the practiceor actual test for the examiner, stored in the database. These promptsmay be provided in response to the examinee's input. A combination ofsoftware instructions executed by the software modules running on server102 and/or client 106 may receive the user input from each task, andanalyze the received input by comparing the examinee's responses againstthe correct answers to responses to task prompts (possibly stored asdata records in database 110) in order to determine if the receivedanswers match the correct answers. The software modules may analyze thereceived input and generate displays or other output including anotification to the user that the user input is correct or incorrect(e.g. “that is/is not correct”), or that it is incorrect (e.g., “that isincorrect because . . . ”), and directing the examinee how to proceed(e.g., “try again from . . . ”). The subject may then be presented witha GUI indicating that the user input included correct or incorrectresponses for the practice test.

As noted above, as the examinee progresses through the practice test,the examinee's input may be analyzed and displayed in real time. Thisclient view may be transmitted from the client GUI to server 102, whichmay render the user input within the client view GUI control, andtransmit the rendering to the examiner GUI in real time, therebyallowing the examiner to view the examinee's responses and other inputin real time. In embodiments where this input is displayed within aclient view GUI control on the examiner GUI (e.g., FIGS. 7, 8, and 10)the examiner may acknowledge and reinforce correct answers.

As seen in FIGS. 11, 12 and 14, the examiner GUI may also includeinstructions for responding to responses input by the examinee. Forexample, FIGS. 7-8 each include a “correct” and “incorrect” tab withinstructions for the examiner to respond according to the examineeinputting a correct or incorrect response, respectively. In someembodiments, if the user input is incorrect, the screen may freeze(e.g., the examinee is unable to make any more responses beyond theerror), the examiner or software may create an X or other visual cuethat the selection or line was incorrect, and/or the practice test maybe otherwise paused while the software or examiner provides feedback.Using these tools, the examiner may monitor the input by the examineefor practice and actual tests.

The examiner GUI may further control the examinee interface, so that ifthe examinee makes a mistake, the software or examiner may pause thepractice test, and provide feedback (e.g., highlighting the mistake)instructing the examinee that the selection was incorrect, and thesoftware or examiner may demonstrate a correct response on the clientview. In some embodiments, the examiner and/or software may, forexample: highlight correct letters, numbers, text, boxes, paths,selections, etc. and create lines showing proper paths, order,selections, etc. The instructions may then direct the examiner (possiblyusing highlights or other visual cues) to direct the examinee to beginagain from the last correct input/decision point.

In some embodiments, the examiner's role may be automated. Thus, asnon-limiting examples, the instructions may be displayed on the clientGUI, the demonstration may be displayed on the client GUI, and theserver may monitor and correct the examinee during the practice exams.

During the actual test, the timer may be started, possibly after theexaminee acknowledges the start, selects the first selection, orresponds to prompts or decision points. The examinee may continueworking through the time provided by the timer without interruption fromthe examiner.

Multi-level subtests and/or tasks, as described below, may beadministered via the disclosed system. Some of these subtests and/ortasks may incorporate cognitive flexibility, meaning that the user mayincorporate compound/complex instructions and working memory, forexample. This may improve the sensitivity and specificity of the scoresfor each task, subtest, or overall test for each examinee, and mayfurther improve the ability to identify the cognitive decline,neurological insult, early stage disease, etc., since performance onthese tasks would be expected to reflect the integrity of both thecognitive functions/abilities, neurological integrity, lack of disease,etc. and memory neural systems. In addition to collecting input from thesubject, additional information may be collected. For example, inaddition to determining whether or not the subject provided correct userinput, the system may be configured to determine the amount of time ittakes the subject to respond to the prompt. The system may record anexaminee's response time to determine how long it takes them to make adecision, for example.

Thus, server 102 may combine the dual-level, triple-level, or othermulti-level tasks, combining multiple various tasks in order to testexecutive function domains, which may allow for additional testing ortracking components that requires the examinee to, for example,determine if they switch or continue with the same sequence. In theexample embodiments described below, an examinee may be required toalter their behavior according to the at least one visual indicatorrequiring a switch. For example, the visual indicator may include: a boxdisplayed around a number, letter, dot, etc.; a change in a characterstring or font color of a character string; an outline or background ofa box displaying the test data; etc. In other words, the dual, triple,and other multiple-level tasks indicated by the visual indicator buildupon the existing D-KEFS testing components to create a higher-levelcondition to assess executive functioning by requiring multiple skillsto be used at the same time.

At the end of each task, subtest, and/or the overall test battery, afterthe examinee has completed all tasks, and/or at the conclusion of thetimer, the software modules may be configured to calculate the testresults based on the examinee's input. For example, the electronic inputprovided by the examinee may be compared with the correct answers storedin association with the selected subtest and/or task within data recordsin the database. The software modules may then run calculations toanalyze the examinee's answers and generate a score including the numberof correct answers for each or all of the tasks for each of thesubtests. The correct or incorrect answers may be calculated accordingto the electronic input matching, or failing to match, a correctresponse associated in database 130 with a task data defining a functionskill demonstrating a cognitive ability of the examinee.

The final score may be compared with a threshold number, and if thescore is below the threshold number, one or more of a cognitive decline,a neurological insult, or an early stage disease may be identified asassociated in the database with the score below the threshold number.The software modules may then store the results in database 110.

Thus, the disclosed system software may determine whether the user hasbeen a good or poor performer in relation to cognitive decline, aneurological insult, or an early stage disease. The software may makethis determination via the algorithms disclosed herein, and may generatethe results of the tests and the interpretation of these test results(e.g., whether or not the subject a poor performer, and therefore atrisk of neurodegenerative disease) in real time. The results of thetests and interpretation of the results may then be displayed as areport to the examiner (e.g., to a physician). The examiner may thenpresent and contextualize the result for the examinee, similar to howthis is currently done with radiology and LP results.

Turning now to FIG. 4, a series of method steps is shown, which apply tothe tests, subtests, and/or tasks requiring actions taken in sequentialorder, possibly with additional instructions, as demonstrated in FIGS.7-11, 13, and 17-19. In these embodiments, the GUI on the client 120 mayreceive user input requesting the Trail Making, Design Fluency, Tower,or Grocery List subtests and/or tasks as demonstrated in FIGS. 7-11, 13,and 17-19.

In step 400, server 102 may identify the selected test, subtest, and/ortask, possibly by receiving from the GUI a unique identifying characterstring (e.g., “Trail Making/Number Sequencing,” “Design Fluency/MixedDots,” “Tower,” “Grocery List,” etc.) or a unique alphanumericidentifier for the selected test, subtest, or task. Server 102 may thenexecute a database query to identify the selected test, subtest, or taskby matching the unique identifying character string or alphanumericidentifier received from the GUI with a test, subtest, or task datarecord within the database 110. Server 102 may then select alladditional data records associated in database 110 with the selectedtest, subtest, and/or task (e.g., by selecting all data recordsincluding the unique character string or alphanumeric identifier for thetest, subtest, and/or task).

In step 405, server 102 may use the data stored in these data records,as well as logic and rules within the software modules running on server102 and/or client 106, to encode and render one or more GUIs to betransmitted to, and displayed on, client(s) 106. The GUI generated andrendered from the data, logic, and rules may include instructions forthe examinee to take the practice and actual tests. In embodiments whereserver 102 generates and renders both an examiner GUI and an examineeGUI displayed within a client view on the examiner GUI, server 102 maygenerate and render the instructions on the examiner GUI for theexaminer to read out loud to the examinee. In embodiments including onlythe examinee GUI, server 102 may generate and render the instructions onthe examinee GUI, or generate an audio output providing the instructionsto the examinee.

In step 410, the GUI generated and rendered from the selected data mayinclude one or more practice tests. Server 102 may analyze the data fromthe selected data records and/or the logic and rules in the softwaremodules in order to determine the layout for the practice test. Forexample, the data, logic, and/or rules may require that: the TrailMaking tasks provide multiple sequential number and letter graphics ortext distributed in random order across the GUI, some of which may besurrounded by boxes, or a sampling of empty dot graphics, with dotslabeled Start and Finish; the Design Fluency tasks provide multiplefilled and empty dot graphics distributed in random order across theGUI, and a “next” GUI control for creating multiple designs, whichcauses the server to generate and display another examinee GUI controlwith a different set of filled and empty dot graphics; the Tower tasksprovide multiple peg graphics and one or more chip graphics to be placedon, and moved between, the pegs; and the Grocery List tasks provide oneor more grocery list graphics displayed at the top of the examinee GUIto be collected, multiple grocery item graphics (some matching thegrocery list items) distributed among one or more aisle graphics, agrocery cart graphic to be moved among the grocery items/aisles, and acheckout graphic. Server 102 may identify, from the selected data,logic, or rules, one or more required text or graphical elements (e.g.,filed or empty dot graphics, numbers and letters to be displayed withinthe graphics, box graphics to be placed around the dot graphics, pegs,chips, grocery items, aisles, grocery cart, checkout, etc.) and renderand display these items on the examinee (and/or client view of theexaminer's) GUI according to the data, logic, and/or rules.

In step 415, using these rendered GUIs, server 102 and/or client 106 mayhighlight the appropriate text or graphics as they are described in theinstructions (e.g., highlighting each number in order, or an exampleline generated between numbers in order; highlighting a correctly drawnline to create a design; highlighting a correct chip to be placed on acorrect peg; highlighting a correct path between the shopping cart andthe first item in the shopping list; etc.).

In step 420, after the instructions for the test, subtest, and/or taskare provided and demonstrated, server 102 may render and display a firstpractice test on the one or more GUIs. The examinee GUI may receive userinput selecting a first displayed item, and transmit the user input toserver 102 for analysis. In step 425, server 102 may compare the firstselected item with a correct first selected item defined within the datarecords, logic, and/or rules (e.g., a dot containing 1 or A, a firstdesignated chip on a first designated peg, selection of the grocery cartto move towards the first grocery item, etc.). In step 430, if theselected first item, and the first item in the data records, logic,and/or rules do not match, server 102 may automatically generate,render, and display a notification that the first item was not correct,and to try again (e.g., provide instructions “that is not correct,please begin again with 1, A, this chip or peg, the grocery cart,etc.”).

In step 435, the examinee GUI may then receive user input selecting anext sequential item (e.g., a user input selecting a dot containing 2after 1, or B after A, or a line connecting 1 to 2 or A to B; a userinput connecting an empty dot to a filled dot within a design; a userinput selecting a chip to move to a different peg; a user input movingthe grocery cart to a first item in the grocery list; etc.), andtransmit the user input to server 102 for analysis. Server 102 maycompare the selected next sequential item with a correct next sequentialitem defined within the data records, logic, and/or rules (e.g., 2follows 1 or B follows A; an empty dot follows a filled dot; a specificchip should be moved in order to a specific peg; a grocery item closestto the grocery cart should be selected first, etc.). In step 440, if theselected next sequential item, and correct next sequential item definedin the data records, logic, and/or rules do not match, server 102 mayautomatically generate, render, and display a notification that theselected next sequential item was not correct, and to try again (e.g.,provide instructions “that is not correct, please begin again with 1, A,this chip or peg, the grocery cart, etc.”). In some embodiments, theexaminee GUI may highlight then incorrect sequential and/or a correctsequential selection.

After the practice test is complete, the examinee or examiner GUI mayreceive user input requesting another practice, and server 102 andclient(s) 106 may repeat the steps above to generate a new practicetest. After all practice tests are complete, the examinee or examinerGUI may receive user input requesting the actual test, and in step 445,server 102 and client(s) 106 may repeat the steps above to generate,render, and display the requested actual test.

However, during the actual test, after comparing the selected nextsequential item with a correct next sequential item defined within thedata records, logic, and/or rules (Step 450), if the selected nextsequential item, and correct next sequential item defined in the datarecords, logic, and/or rules match, in step 455, server 102 mayautomatically increase the examinee's score. If the selected nextsequential item, and correct next sequential item defined in the datarecords, logic, and/or rules do not match, in step 460, server 102 mayautomatically decrease examinee's score. Once the actual test iscomplete, or the timer has run out, server 102 may automaticallygenerate a final score for the examinee, and identify potentialcognitive decline, as disclosed above.

Turning now to FIG. 5, a series of method steps is shown, which apply tothe tests, subtests, and/or tasks requiring actions taken matching aprompt provided through the GUI(s) with a character string and/orgraphic matching an element of the prompt (e.g., matching characterstring, color, tone of voice, etc.), possibly with additionalinstructions, as demonstrated in FIGS. 10, 12, and 13-14 and 18-19 Inthese embodiments, the GUI on the client 120 may receive user inputrequesting the Verbal Fluency, Social Sorting, Color Word Interference,Prosody Word Interference, or Derby subtests and/or tasks asdemonstrated in FIGS. 12, and 14-16 and 18-19 (Verbal Fluency subtestnot shown).

In step 500, server 102 may identify the selected test, subtest, and/ortask, possibly by receiving from the GUI a unique identifying characterstring (e.g., “Verbal Fluency/Letter Fluency,” “Social Sorting/EmotionSorting,” “Color Word Interference/Color Identification,” “Prosody WordInterference/Emotion Naming,” “Derby,” etc.) or a unique alphanumericidentifier for the selected test, subtest, or task. Server 102 may thenexecute a database query to identify the selected test, subtest, or taskby matching the unique identifying character string or alphanumericidentifier received from the GUI with a test, subtest, or task datarecord within the database 110. Server 102 may then select alladditional data records associated in database 110 with the selectedtest, subtest, and/or task (e.g., by selecting all data recordsincluding the unique character string or alphanumeric identifier for thetest, subtest, and/or task). Step 505 may proceed in a manner analogousto step 405 described above.

In step 510, the GUI generated and rendered from the selected data mayinclude one or more practice tests. Server 102 may analyze the data fromthe selected data records and/or the logic and rules in the softwaremodules in order to determine the layout for the practice test. Forexample, the data, logic, and/or rules may require that: the VerbalFluency tasks provide multiple letters and/or categories (either fordisplay or as an audio output), and a GUI control for receiving userinput; the Social Sorting tasks provide a series of key card graphics,several graphics representing a card deck, and a series of GUI controlsfor receiving a user input attempting a match of a card in the key cardgraphics and a card from the card deck; the Color Word Interferencetasks provide one or more boxes, which may be displayed indifferent/offset positions, including a color, a background color, acharacter string, a font color, and/or a border color, and a series ofboxes each including a character string describing a match to the color,the background color, the character string, or the font color; theProsody Word Interference tasks provide multiple audio outputs stating aword and/or stating it in a tone of voice, and multiple boxes, eachincluding a character string describing a match to the word and/or thetone of voice; and the Derby tasks provide a racetrack, horses andjockeys, monetary selection boxes, a finish line, and a running total ofmoney. Server 102 may identify, from the selected data, logic, or rules,one or more required text or graphical elements (e.g., letters and/orcategories output or displayed and a GUI control for user input, cardsand card slots for matching, series of boxes with character strings,possibly with a specific background, border, or font color, racetrackand money graphics, etc.) and render and display these items on theexaminee (and/or client view of the examiner's) GUI according to thedata, logic, and/or rules. In step 515, using these rendered GUIs,server 102 and/or client 106 may highlight the appropriate text orgraphics as they are described in the instructions (e.g., highlighting aletter or category to input matching character strings, or a card in acard deck matching specific key cards, or each character string in boxesmatching a correct character string, audio output, tone of voice,background color, font color, etc.).

In step 520, after the instructions for the test, subtest, and/or taskare provided and demonstrated, server 102 may render and display a firstpractice test on the one or more GUIs, possibly including required audiooutput. The examinee GUI may receive user input including a selection ofcharacter strings matching a letter and/or category, a card in the carddeck matching a key card, a box including a character string matchingthe audio output, a tone of voice in the audio output, a backgroundcolor, character string, font color, displayed in another box, aselected horse and jockey etc., and transmit the user input to server102 for analysis. In step 525, server 102 may compare the selected itemwith a correct selected item defined within the data records, logic,and/or rules (e.g., an input matching the correct letter or category, acard in the card deck matching a card in the key cards, a selected boxmatching the character string, font color, or background color ofanother box, the winning horse and jockey, etc.). In step 530, if theselected item, and the item in the data records, logic, and/or rules donot match, server 102 may automatically generate, render, and display anotification that the selected item was not correct, and to try again(e.g., provide instructions “that is not correct, please make anotherselection or begin again”).

After the practice test is complete, the examinee or examiner GUI mayreceive user input requesting another practice, and server 102 andclient(s) 106 may repeat the steps above to generate a new practicetest. After all practice tests are complete, the examinee or examinerGUI may receive user input requesting the actual test, and in step 535,server 102 and client(s) 106 may repeat the steps above to generate,render, and display the requested actual test.

However, during the actual test, after comparing the input selected itemwith a correct input selected item defined within the data records,logic, and/or rules (Step 550), if the input selected item, and correctselected item defined in the data records, logic, and/or rules match, instep 545, server 102 may automatically increase the examinee's score. Ifthe input selected item, and correct selected item defined in the datarecords, logic, and/or rules do not match, in step 560, server 102 mayautomatically decrease examinee's score. Once the actual test iscomplete, or the timer has run out, server 102 may automaticallygenerate a final score for the examinee, and identify potentialcognitive decline, as disclosed above.

FIG. 6 represents a streamlined method of including multiple executivefunctions within a single task. In step 600, the server generates: afirst series of user interface objects comprising a first sequence or aplurality of character string descriptions; a second series of userinterface objects comprising a second sequence or a plurality of userinterface characteristics; and at least one visual indicator displayobject requiring a switch between the first series of user interfaceobjects, and the second series of user interface objects. In step 610,the server encodes, for display on a client hardware computing device, agraphical user interface (GUI) comprising the first series of userinterface objects, the second series of user interface objects, and theat least one visual indicator display object. In step 620, the serverdecodes, from the GUI, an electronic input from a user switching fromthe first series of user interface objects, displayed in associationwith the visual indicator display object, to the second series of userinterface objects. In step 630, the server calculates a score for theelectronic input according to the electronic input matching, or failingto match, a correct response associated in a database with a task datadefining a function skill demonstrating a cognitive ability of a user.In step 640, responsive to the score being below a predeterminedthreshold, identify a cognitive decline, a neurological insult, or anearly stage disease associated in the database with the score below thepredetermined threshold.

Turning now to FIGS. 7-10, the Trail Making subtest may include, asnon-limiting examples, Number Sequencing, Letter Sequencing, ComplexSwitching, Distraction, Working Memory, Visual Scanning, and Motor Speedtasks, each of which is described in detail below. The Trail Makingsubtest may evaluate executive function domains includingCognitive/Behavioral Control, Cognitive Flexibility (multiplesimultaneous tasks), Inhibitory Control, Self-Monitoring, and RuleViolations.

Turning now to FIG. 7, the examinee GUI for the number sequencing taskmay display data similar to that in the non-limiting example GUI in FIG.7, and an examiner GUI may include a client view display, and generaland correct/incorrect response instructions, as described above. As seenin FIG. 7, the number sequence examinee GUI may include a combination ofcircled letters and numbers scattered in random order across the GUI.The instructions may direct the examinee to select the numbers in orderand/or to draw a line between the numbers in sequential order, untilreaching the end (e.g., the number 5 in FIG. 7).

The examinee may progress through the number sequencing practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, as seen in FIG. 7, if theexaminee selects or proceeds from 1 to 3 (demonstrated by a dottedline), the error feedback may instruct the examinee that the examineeshould touch the numbers in order, and thus should have gone from 1 to2. In this example, the examinee may be instructed to try again startingat 1. In another example seen in FIG. 7, if the examinee selects orproceeds from 1 to A (demonstrated by a dotted line), the error feedbackmay instruct the examinee that the examinee should touch only thenumbers in order, and thus should have gone from 1 to 2. In thisexample, the examinee may be instructed to try again starting at 1. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to theirselection of the numbers in the correct sequence.

Turning now to FIG. 8, the examinee GUI for the letter sequencing taskmay display data similar to that in the non-limiting example GUI in FIG.8, and an examiner GUI may include a client view display, and generaland correct/incorrect response instructions, as described above. As seenin FIG. 8, the letter sequence examinee GUI may include a combination ofcircled letters and numbers scattered in random order across the GUI.The instructions may direct the examinee to select the letters in orderand/or to draw a line between the letters in sequential order, untilreaching the end (e.g., the letter E in FIG. 8).

The examinee may progress through the letter sequencing practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, as seen in FIG. 8, if theexaminee selects or proceeds from A to C (demonstrated by a dottedline), the error feedback may instruct the examinee that the examineeshould select the letters in order, and thus should have gone from A toB. In this example, the examinee may be instructed to try again startingat A. In another example seen in FIG. 8, if the examinee selects orproceeds from A to 1 (demonstrated by a dotted line), the error feedbackmay instruct the examinee that the examinee should touch only theletters in order, and thus should have gone from A to B. In thisexample, the examinee may be instructed to try again starting at A. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to the selectionof the letters in the correct sequence.

Though not shown, the examinee GUI for the number/letter switching taskmay display a combination of circled letters and numbers scattered inrandom order across the GUI, as seen in FIGS. 7, 8, and 9, and anexaminer GUI may include a client view display, and general andcorrect/incorrect response instructions, as described above. Theinstruction may direct the examinee to select or draw a line from number1 to the letter A, then number 2, then the letter B and so on, in order,until reaching the end (e.g., the letter E in FIGS. 7, 8, and 9).

The examinee may progress through the number/letter switching practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee touches orproceeds from 1 to C, the error feedback may instruct the examinee thatthe examinee switched between numbers and letters, but that they didn'tgo in order, and thus should have gone from 1 to A. In this example, theexaminee should try again starting at 1. In another example, if theexaminee touches or proceeds from 1 to 2, the error feedback mayinstruct the examinee that the examinee needs to remember to switchbetween numbers and letters in order, and thus should have gone from 1to A. In this example, the examinee should try again starting at 1. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to switchingbetween the selection of numbers and letters in the correct sequence.

Turning now to FIG. 9, the examinee GUI for the complex switching taskmay display data similar to that in the non-limiting example GUI in FIG.9, and an examiner GUI may include a client view display, and generaland correct/incorrect response instructions, as described above. As seenin FIG. 9, the complex switching examinee GUI may include a combinationof circled letters and numbers scattered in random order across the GUI,with some of the letters and numbers displayed in boxes. Theinstructions may be the same as the switching task described above,where the examinee receives instructions to switch between selecting ordrawing lines between numbers and letters in order. However, if thenumber or letter is inside a box, the instructions may direct theexaminee not to switch, but select or draw a line from letter to letteror from number to number.

For example, as seen in FIG. 9, the examinee may be instructed to firsttouch the number 1, and because it is a circle, the examinee shouldswitch and select or draw a line to A. A is in a box, so theinstructions may direct the examinee to switch, and select or draw aline to B, which is a circle, so the instructions may direct theexaminee to switch and select or draw a line to the next number, 2, andso on, in order, until the examinee reaches the end (e.g., E in FIG. 9).

The examinee may progress through the complex switching practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee touches orproceeds from a number to a letter (or vice versa) when a box isdisplayed, the error feedback may instruct the examinee that when thenumber or letter is in a box that the examinee should touch or draw aline to the next number or letter, respectively, in order, and thusshould have gone from letter to letter or number to number. In thisexample, the examinee should try again starting at the last correctletter or number. In another example, if the examinee touches orproceeds from a number to number or letter to letter when a box is notdisplayed, the error feedback may instruct the examinee that when thenumber or letter is not in a box that the examinee should switch toselect or draw a line to the next letter or number, respectively, inorder by switching from number to letter or letter to number accordingto the last selected number or letter, and thus should have gone fromletter to number or number to letter. In this example, the examineeshould try again starting at the last correct letter or number. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to switching,then moving from letter to letter or number to number if the letter ornumber is within a box.

The GUI and other parameters for the practice test and actual test forthe working memory task may have any or all characteristics describedabove for the number sequencing, letter sequencing, switching, complexswitching, or distraction tasks. However, during the practice tests andactual tests, the GUI may display a line between each selected letterand/or number. For example, in the switching task, a line may appearbetween 1 and A as the user selects or draws a line between each.However, after a limited amount of time, (e.g., one second), the linemay then disappear. Thus, the instructions may direct the examinee thatthe lines will disappear and that the examinee must therefore keep trackof their progress through the task.

Though not shown, the examinee GUI for the visual scanning task maydisplay a combination of circled letters and numbers scattered in randomorder across the GUI, as seen in FIGS. 7, 8, and 9, and an examiner GUImay include a client view display, and general and correct/incorrectresponse instructions, as described above. However, in the visualscanning task, the GUI may include multiple copies of a single letter(e.g., multiple 3s scattered across the GUI) or number (e.g., multipleCs scattered across the GUI). The instruction may direct the examinee toselect or otherwise mark each of the designated letters or numbers(e.g., draw a line through each of the 3s or Cs).

The examinee may progress through the visual scanning practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee selectsnumbers other than 3 or C in the example above, the error feedback mayinstruct the examinee to select only the designated number or letter(e.g. 3s, Cs). In this example, the examinee should try again with thenext unmarked 3. The examinee may repeat the practice test, and/or takeadditional practice tests, and after one or more practice tests, theexaminee may take the actual test and be scored as described above,according to correct selection of numbers or letters.

Turning now to FIG. 10, the examinee GUI for the motor speed task forthe examinee's dominant and non-dominant hands may display data similarto that in the non-limiting example GUI in FIG. 10, and an examiner GUImay include a client view display, and general and correct/incorrectresponse instructions, as described above. As seen in FIG. 10, the motorspeed examinee GUI may include a start circle and an end circle, as wellas a combination of circles scattered in random order forming a pathacross the GUI. The instructions may direct the examinee to select thecircles and/or to draw a line between circles with a dominant, then anon-dominant hand in sequential order.

The examinee may progress through the motor speed practice tests usingtheir dominant and non-dominant hands, where correct answers arereinforced and incorrect answers are identified as disclosed above. Forexample, as seen in FIG. 10, if the examinee selects or proceeds throughthe circles out of order (demonstrated by a dotted line), the errorfeedback may instruct the examinee to proceed through the circles inorder from start to end. In this example, the examinee may be instructedto try again starting at the last correct circle, or at the startcircle, as shown. In another example, if the examinee uses the incorrecthand, the error feedback may instruct the examinee to proceed throughthe circles in order from start to end using the correct hand. In thisexample, the examinee may try again using the correct hand. The examineemay repeat the practice test, and/or take additional practice tests, andafter one or more practice tests, the examinee may take the actual testusing both dominant and non-dominant hands, and be scored as describedabove, according to their selection of the circles in the correctsequence.

The GUI and other parameters for the practice test and actual test forthe switching with distraction task may have any or all characteristicsdescribed above for any of the previously disclosed trail making tasks.However, during the practice tests and actual tests, the examinee mayhear sounds and see objects on the screen. The instructions may directthe examinee to ignore the sounds or displayed objects, and focus onlyon selecting, drawing lines, and/or switching between the numbers andletters in the correct order.

Turning now to FIG. 18, the examinee GUI for the number/letter switchingtask with distractions (possibly including auditory distractions) maydisplay data similar to that in the non-limiting example GUI in FIG. 18,and an examiner GUI may include a client view display, and general andcorrect/incorrect response instructions, as described above. As seen inFIG. 18, the switching with distraction examinee GUI may include acombination of circled letters and numbers scattered in random orderacross the GUI. The instructions may be the same as the number/letterswitching task described above, where the examinee receives instructionsto switch between selecting or drawing lines between numbers and lettersin order.

The switching with distraction GUI, as part of the trail making test,may also include an additional condition, including visual or audiodistractions, possibly stored within, and generated by, the disclosedsystem, which continue throughout the task. The more general tests maytherefore be administered first, and then again with the distractionstasks added to the assessment. The distraction task may introducecompeting stimuli to the original task to distract an examinee fromaccurately completing the task. By using the same scoring rubric thedifferences may be analyzed.

Given the computer-based nature of the disclosed embodiments, the systemmay generate visual or audio stimuli, from visual and audio files storedon within the system, which is presented at particular times during thetask to distract the user from the task objective. Thus, in someembodiments, these distractions may include an audio file including avoice saying numbers and letters. In some embodiments, numbers andletters may be generated in such a way that they appear and disappearfrom the switching with distraction examinee GUI. However, unlike thecombination of numbers and letters spread across the screen, asdisclosed above, the generated letters and number may be displayedwithout a circle, as seen for the letter A and the number 2 in FIG. 18.

In embodiments such as the example embodiment in FIG. 18, the examineemay be instructed that they may hear a voice say numbers and lettersand/or see numbers and letters, which will not be in circles and willappear and disappear on the screen. For example, the examinee may beinstructed to first touch the number 1, but never to touch a distractionnumber or letter (e.g., the 2 or A that are displayed in FIG. 18), thento switch and select or draw a line to A within a circle. Theinstructions may further direct the examinee to continue switching, forexample, proceeding from A to 2, and from 2, selecting or draw a line toB, and so forth, so that the instructions may direct the examinee toswitch and select or draw lines switching between numbers and letterswithin circles, in order, until the examinee reaches the end (e.g., E inFIG. 18).

As the examinee progresses through the switching task with distractions,the system may access and play the audio files, possibly including avoice saying numbers or letters as contained in the audio file, and/oraccess and display any combinations of letters and numbers without acircle (e.g., “A” in FIG. 18), scattered across the GUI in random order,but in different positions than the numbers and letters including thecircle. Thus, the audio files and/or the letters and numbers withoutcircles may act as distractors to the examinee, so that while theexaminee is conducting the tasks, non-random misleading audio and visualdistractions may be introduced.

In some embodiments the placement of the combination of letters ornumbers may be designed to appear in orders or positions calculated tomake the user want to click on the distraction. For example, thedistractors may be time-linked to the behavior of the examinee based onthe next expected response by the system in such a way as to push theexaminee towards an incorrect response, which the user will need toignore to correctly complete the task.

One or more algorithms within the disclosed system may determine thetype of potential distractor, and when to display the potentialdistractors. In some embodiments, the locations of the distractors maybe preprogrammed locations according to the visual or other proximity tothe current number/letter within a circle in the trail making task. Insome embodiments, the user may also be required to avoid connectinglines where the lines stay present.

As a non-limiting example, in FIG. 18, the user may be instructed tobegin the practice or actual testing by selecting the circled number 1.The examinee GUI may further include a display of a non-circle number 1,along with other potential distractors. The user may then be instructedto proceed, and may proceed, from 1 to A, from A to 2, from 2 to B, andso on. As seen in FIG. 18, the examinee may touch or click the 1 withinthe circle, as instructed (indicated by the filled oval in FIG. 18), andthe system may remove the display of the non-circle 1, and select andpresent, for display on the examinee GUI, additional distractors, suchas the non-circle letter A (possibly including the accompanying audiofile) and the number 2. In this example embodiment, the non-circle 1, 2,and A may all be displayed in the same font type and size as the numbersand letters inside circles. Though not shown, once the user selects A(or draws a line from 1 to A), the non-circle B may appear, thenon-circle 2 may stay, and, in embodiments including an audio component,the audio file may include a voice saying “B,” and so forth.

As seen in FIG. 18 and noted above, the layouts for the trail makingtasks may be designed so that the distractors have a visual proximity tosimilar or current numbers or letters within circles along the path, inan attempt to trick the user or pull them away from the correct sequencewithin the path. The visual distractors may also be accompanied by audiodistractors, both of which may be selected as audio files and visualfiles by the system and presented at the same time. The numbers orletters within circles, and the non-circle distractor numbers or lettersmay therefore be related but incongruous.

The progression described thus far may continue throughout the practiceor actual tests, removing some letters or numbers and replacing themwith others displayed on the switching and distraction GUI.

The examinee may progress through the number/letter switching practicetest with distractions, where correct answers are reinforced andincorrect answers are identified as disclosed above. For example, if theexaminee touches or proceeds from 1 to C, the error feedback mayinstruct the examinee that the examinee switched between numbers andletters, but that they didn't go in order, and thus should have gonefrom 1 to A. In this example, the examinee should try again startingat 1. In another example, if the examinee touches or proceeds from 1 to2, the error feedback may instruct the examinee that the examinee needsto remember to switch between numbers and letters in order, and thusshould have gone from 1 to A. In this example, the examinee should tryagain starting at 1.

The examinee may repeat the practice test, and/or take additionalpractice tests, and after one or more practice tests, the examinee maytake the actual test and be scored as described above, according toswitching between the selection of numbers and letters in the correctsequence.

The scoring rubric may directly compare the performance of the practiceor actual test with distractions to an identical task without thedistractions, in order to determine what the cost of distraction forthat examinee. The system may therefore anticipate examinees taking thepractice or actual test with and without the distractors in order togenerate a delta to determine the effect of distractors on the people.

The scoring rubric for the number and letter switching task withdistractors may be incorporated into the scoring rubric generally. Asnoted above, the distractors may affect the time required to completethe tasks within the instructions, which may, in turn, create a morefocused identification of the reason for the cognitive decline followinghead trauma or neurological insult, for example. Thus, a primaryvariable for scoring each of the tasks is the speed it takes an examineeto complete it. If this time increases significantly in the presence ofa distraction, the examinee's likelihood that the user is easilydistracted is also increased.

The disclosed embodiments may also assess examinees who perform the testwell when there are no distractions, and compare this with distractionembodiments, do determine whether the examinees make errors when thereare distractions. In other words, in distraction embodiments, thedistractions may both slow down the user, and may cause them to make thewrong choice. For example, the user may make sequencing or switchingerrors as disclosed above, and the scoring rubric may be adjusted toconsider error rate and types of errors in scoring the examinee.

Additional responsive embodiments may be envisioned, wherein, as theuser performs better and better, additional increased difficulty fordistractions are introduced. For example, the user may begin with onlyaudio distractions, and as they continue to progress, visualdistractions may be introduced, or vice versa. In some embodiments, thetypes of distractors may be particularly distracting to a particulartype of person (e.g., person distracted by visual more than audiodistractors, for example).

Thus, the Trail Making subtest may evaluate executive function domainsincluding Cognitive/Behavioral Control, Inhibitory Control,Self-Monitoring, and Rule Violations to determine the cognitiveabilities of the examinee. Specifically, the number sequencing, lettersequencing, and motor speed tasks track the examinee's cognitiveabilities to select or connect dots in consecutive order. The visualscanning task likewise tracks the examinee's cognitive ability torecognize instances of the same letter or number within the GUI field.

The Trail Making subtest also demonstrates the Cognitive Flexibilityexecutive function domain. The input task data demonstrates multiplesimultaneous function skills to determine the cognitive abilities of theexaminee being used simultaneously. Specifically, the distraction tasktests the examinee's cognitive ability to ignore distractions whilemaintaining the ability to proceed sequentially through any of thedisclosed tests. The switching task tracks the examinee's cognitiveability to switch while maintaining the ability to proceed sequentiallythrough the disclosed tests. The complex switching task tracks theexaminee's cognitive ability to switch or continue with the samesequence in switching tasks, by proceeding letter to letter or number tonumber if a visual cue is provided. The working memory task tracks theexaminee's cognitive ability to proceed through any combination of thedisclosed tests without visual cues for the examinee's previousprogress.

Though not shown, the Verbal Fluency subtest may include, asnon-limiting examples, Letter Fluency, Category Fluency, and Switchingtasks, each of which is described in detail below. The Verbal Fluencysubtest may evaluate executive function domains includingCognitive/Behavioral Control, Cognitive Flexibility (multiplesimultaneous tasks), Rule Violations, and Behavioral Productivity(Initiation).

Though not shown, the examinee GUI for the letter fluency task mayprovide a letter, either as an audio file, or displayed on the letterfluency examinee GUI, and a GUI control (e.g., text box, text area,audio capture, etc.), for receiving input from the user. An examiner GUImay include a client view display, and general and correct/incorrectresponse instructions, as described above. The instructions may directthe examinee to enter or speak as many words that start with theprovided letter that the examinee can think of during the provided timeperiod (e.g., 60 seconds).

The examinee may progress through the letter fluency practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee is given theletter F, and enters one or more entries that do not begin with theletter F, the error feedback may instruct the examinee to enter wordsbeginning with the letter F. In this example, the examinee may try againstarting at the incorrect entry. The examinee may repeat the practicetest, and/or take additional practice tests, and after one or morepractice tests, the examinee may take the actual test and be scored asdescribed above, according to their ability to list words starting withthe correct letter.

Though not shown, the examinee GUI for the category fluency task mayprovide a category (e.g., animals, fruits and vegetables, instruments,clothing, etc.), either as an audio file or displayed on the categoryfluency examinee GUI, and a GUI control for receiving input from theuser as described above. An examiner GUI may include a client viewdisplay, and general and correct/incorrect response instructions, asdescribed above. The instructions may direct the examinee to enter orspeak as many words that belong to the provided category that theexaminee can think of during the provided time period.

The examinee may progress through the category fluency practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee is given thecategory animals, and enters one or more entries that do not belong tothat category, the error feedback may instruct the examinee to enterwords that belong to the correct category (animals). In this example,the examinee may try again starting at the incorrect entry. The examineemay repeat the practice test, and/or take additional practice tests, andafter one or more practice tests, the examinee may take the actual testand be scored as described above, according to their ability to listwords associated with the correct category.

Though not shown, the examinee GUI for the letter/category fluency taskmay provide a letter and a category, either as audio files or displayedon the letter/category fluency examinee GUI, and a GUI control forreceiving input from the user as described above. An examiner GUI mayinclude a client view display, and general and correct/incorrectresponse instructions, as described above. The instructions may directthe examinee to enter or speak as many words that both include theprovided letter, and also belong to the provided category, that theexaminee can think of during the provided time period.

The examinee may progress through the letter/category fluency practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the examinee is given theletter F and the category animals, and enters one or more entries thatdo not contain the letter and/or do not belong to that category, theerror feedback may instruct the examinee to enter words that include theletter and belong to the correct category. In this example, the examineemay try again starting at the incorrect entry. The examinee may repeatthe practice test, and/or take additional practice tests, and after oneor more practice tests, the examinee may take the actual test and bescored as described above, according to their ability to list wordsincluding the correct letter and associated with the correct category.

The GUI and other parameters for the practice test and actual test forthe category/letter switching task may have any or all characteristicsdescribed above for the letter, category, and/or letter/category fluencytasks. However, during the practice tests and actual tests, theinstructions may direct the examinee to alternate between listing wordsstarting with the provided letter and listing words belonging to theprovided category.

Thus, the Verbal Fluency subtest may evaluate executive function domainsincluding Cognitive/Behavioral Control; Rule Violations; and BehavioralProductivity (Initiation) to determine the cognitive abilities of theexaminee. Specifically, the letter fluency, category fluency, andletter/category fluency tasks track the examinee's cognitive abilitiesto list words associated with the letter and/or category. The VerbalFluency subtest also demonstrates the Cognitive Flexibility executivefunction domain. The input task data demonstrates multiple simultaneousfunction skills to determine the cognitive abilities of the examineebeing used simultaneously. Specifically, the letter/category fluencytask tests the examinee's cognitive ability to list words including boththe letter and category provided. The category/letter switching tasktracks the examinee's cognitive ability to switch while maintaining theability to provide words alternating between letter and category.

Turning now to FIG. 11, the Design Fluency subtest may include, asnon-limiting examples, Mixed Dots, Switching, and Distraction tasks,each of which is described in detail below. The Design Fluency subtestmay evaluate executive function domains including Cognitive/BehavioralControl, Cognitive Flexibility (multiple simultaneous tasks),Self-Monitoring, Rule Violations, and Behavioral Productivity(Initiation).

As seen in FIG. 11, the examinee GUI for the mixed dots task may displaydata similar to that in the client view of the non-limiting example GUIin FIG. 11, and an examiner GUI may include a client view display, andgeneral and correct/incorrect response instructions similar to thoseshown in FIG. 11, and as described above. As seen in the client view ofFIG. 11, the mixed dots examinee GUI may include any combination offilled dots and empty dots scattered in random order across the GUI. Theinstructions (which differ from those displayed in FIG. 11) may directthe examinee to draw 4 lines connecting any combination of filled orempty dots in order to design a unique pattern with lines and dots. Theexaminee may further be instructed to click a “next” button in order tocreate multiple patterns, each of which should be unique and distinctfrom any previous patterns.

The examinee may progress through the mixed dots practice test, wherecorrect answers are reinforced and incorrect answers are identified asdisclosed above. For example, if the examinee creates a pattern usingmore or less than 4 lines between dots, the error feedback may instructthe examinee that the examinee should use no more or less than 4 linescreated by connecting dots and thus should have connected at least 4sets of dots to create the unique pattern. In this example, the examineemay try again either to redesign an existing design, or by starting anew design. In another example, if the examinee creates two identicaldesigns, the error feedback may instruct the examinee that two or moreof the designs are the same, and that each design created by theexaminee should be unique and distinct from any previously createddesigns. In this example, the examinee should try again either toredesign an existing design, or by starting a new design. The examineemay repeat the practice test, and/or take additional practice tests, andafter one or more practice tests, the examinee may take the actual testand be scored as described above, according to their design of uniquedesigns using 4 lines between the provided dots.

The GUI and other parameters for the practice test and actual test forthe filled/empty dot switching task may have any or all characteristicsdescribed above for the mixed dots task. However, in addition todirecting the examinee to create 4 distinct designs using 4 linesbetween dots, the instructions may further direct the examinee to switchbetween touching and/or drawing lines between filled dots and emptydots, as seen in the client view of FIG. 11.

The examinee may progress through the filled/empty dot switchingpractice test, where correct answers are reinforced and incorrectanswers are identified as disclosed above. For example, in addition tothe error feedback provided in the mixed dots examples above, if theexaminee creates a pattern, but does not create the pattern byalternating between empty dots and filled dots, the error feedback mayinstruct the examinee that the examinee should remember to make eachline by switching between empty and filled dots. In this example, theexaminee should try again starting at the last correct line alternatingbetween empty and filled dots, or possibly creating a new pattern. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to their designof unique designs using 4 lines alternating between the provided emptyand filled dots.

The GUI and other parameters for the practice test and actual test forthe design with distraction task may have any or all characteristics forthe mixed dots task and/or the empty/filled dot switching task describedabove. However, during the practice tests and actual tests, the examineemay hear sounds and see objects on the screen. The instructions maydirect the examinee to ignore the sounds or displayed objects, and focusonly on designing the designs according to the instructions.

Thus, the Design Fluency subtest may evaluate executive function domainsincluding Cognitive/Behavioral Control, Self-Monitoring, RuleViolations, and Behavioral Productivity (Initiation) to determine thecognitive abilities of the examinee. Specifically, the mixed dots tasktracks the examinee's cognitive abilities to design multiple uniquedesigns using 4 lines between the provided dots. The Design Fluencysubtest also demonstrates the Cognitive Flexibility executive functiondomain. The input task data demonstrates multiple simultaneous functionskills to determine the cognitive abilities of the examinee being usedsimultaneously. Specifically, the filled/empty dot switching task teststhe examinee's cognitive ability to design unique designs using 4 linesbetween dots while simultaneously alternating between the provided emptyand filled dots. The design with distraction task tests the examinee'scognitive ability to ignore distractions while maintaining the abilityto design unique designs in combination with any of the disclosed tests.

Turning now to FIG. 12, the Color Word Interference subtest may include,as non-limiting examples, Color Identification, Word Identification,Inhibition, Switching, and Distraction tasks, each of which is describedin detail below. The Color Word Interference subtest may evaluateexecutive function domains including Cognitive/Behavioral Control,Cognitive Flexibility (multiple simultaneous tasks), Inhibitory Control,Self-Monitoring, and Rule Violations.

Returning now to FIG. 12, the examinee GUI for the color identificationtask may display data similar to that in the client view of thenon-limiting example GUI in FIG. 12, and an examiner GUI may include aclient view display, and general and correct/incorrect responseinstructions, similar to those seen in FIG. 12, and as described above.As seen in FIG. 12, the color identification examinee GUI may include aseries of boxes, including a box in a first top row, and multiple boxesin a lower row. Though not shown in FIG. 12, the examinee GUI for thecolor identification task may fill the top row box with a solid color.The multiple boxes in the lower row may each display a text stringforming a word describing a color. The instructions (which differ fromthose displayed in FIG. 12) may direct the examinee to select the wordin one of the multiple boxes in the lower row that describes the solidcolor in the top row box.

The examinee may progress through the color identification practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the top row box displaysa red filled box, and the examinee selects a box containing a worddescribing a color other than that in box in the first top row (e.g.,blue), the error feedback may instruct the examinee that the examineeshould select the box including the word for the color (e.g., red), andthus should have selected the box with the text string red rather thanblue. In this example, the examinee may try again starting with a newtop row box and new boxes on the lower row, or restart the previoustask. The examinee may repeat the practice test, and/or take additionalpractice tests, and after one or more practice tests, the examinee maytake the actual test and be scored as described above, according totheir selection of the correct box containing the word describing thedisplayed color.

Returning to FIG. 12, the examinee GUI for the word identification taskmay display data similar to that in the client view of the non-limitingexample GUI in FIG. 12, and an examiner GUI may include a client viewdisplay, and general and correct/incorrect response instructions,similar to those seen in FIG. 12, and as described above. As seen inFIG. 12, the word identification examinee GUI may include the rows andboxes described above. As seen in FIG. 12, the examinee GUI for the toprow box of the word identification task may include a text stringforming a word describing a color. The multiple boxes in the lower rowmay each also display a text string forming a word describing a color,and one of these boxes may match the text string in the box in the firsttop row. The instructions (which differ from those displayed in FIG. 12)may direct the examinee to select the word in one of the multiple boxesin the lower row that matches the text string forming the word in thebox in the top row.

The examinee may progress through the word identification practice test,where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the box in the first toprow displays the word “blue”, and the examinee selects a box containinga word describing a color other than that in box in the first top row(e.g., red), the error feedback may instruct the examinee that theexaminee should select the box including the word matching the box inthe first top row (e.g., blue or green), and thus should have selectedthe box with blue rather than red. In this example, the examinee may tryagain starting with a new top row box and new boxes on the lower row, orrestart the previous task. The examinee may repeat the practice test,and/or take additional practice tests, and after one or more practicetests, the examinee may take the actual test and be scored as describedabove, according to their selection of the correct box containing theword matching the word in the first top row box.

Returning to FIG. 12, the examinee GUI for the color word inhibitiontask may display data similar to that in the client view of thenon-limiting example GUI in FIG. 12, and an examiner GUI may include aclient view display, and general and correct/incorrect responseinstructions, similar to those seen in FIG. 12, and as described above.As seen in FIG. 12, the word identification examinee GUI may include therows and boxes described above. However, in FIG. 12, the examinee GUIfor the top row box of the word identification task may include a textstring forming a word describing a color, but may be displayed in a fontcolor other than the color described by the text string. The multipleboxes in the lower row may each display a text string forming a worddescribing a color, and one of these boxes may match a text stringforming a word describing the font color of the text string within thetop row box. The instructions may direct the examinee to select the wordin one of the multiple boxes in the lower row that matches the fontcolor of the text string forming the word within the top row box.

The examinee may progress through the color word inhibition practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the top row box displaysthe word “blue,” but is displayed in a red font, and the examineeselects a box containing a word describing a color other than the fontcolor for the word within the top row box (e.g., blue, as shown in FIG.12, or green), the error feedback may instruct the examinee that theexaminee should select the box including the word matching the fontcolor of the word within the top row box (e.g., red), and thus shouldhave selected the box with red rather than blue or green. In thisexample, the examinee may try again starting with a new top row box andnew boxes on the lower row, or restart the previous task. The examineemay repeat the practice test, and/or take additional practice tests, andafter one or more practice tests, the examinee may take the actual testand be scored as described above, according to their selection of thecorrect box containing the word matching the font color of the word inthe first top row box.

The GUI and other parameters for the practice test and actual test forthe color/word switching task may have any or all characteristicsdescribed above for the color identification, the word identification,and/or the color word inhibition tasks described above. However, inaddition to directing the examinee to select the correct color or wordin the top row box, the instructions may further direct the examineethat if the top row box includes a visual indicator (e.g., the outlineor background for the box is yellow), to select either a box in thelower row that matches the word in the top row box, or to select the boxin the lower row containing the word that matches the color or fontcolor of the word in the top row box, thereby switching betweenidentifying words and identifying colors according to the instructions,as seen in FIG. 12.

The examinee may progress through the color/word switching practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, in addition to the errorfeedback provided in the color identification, word identification,and/or color/word task inhibition examples above, if the examineeselects a word matching the word in the top row box, because of theyellow outline around, or background within, the box, when they shouldhave selected the word describing the color, or vice versa, according tothe instructions, the error feedback may instruct the examinee that theexaminee should switch when the yellow outline is around the box,according to the instructions. In this example, the examinee should tryagain starting at the last correct color or word match selection, orpossibly creating a new examinee GUI. The examinee may repeat thepractice test, and/or take additional practice tests, and after one ormore practice tests, the examinee may take the actual test and be scoredas described above, according to their selection of correct matches tocolors and words, based on the visual indicator and the instructions.

The GUI and other parameters for the practice test and actual test forthe color word interference with distraction task may have any or allcharacteristics for color identification, word identification,inhibition, and/or switching tasks described above. However, during thepractice tests and actual tests, the examinee may hear sounds and seeobjects on the screen. The instructions may direct the examinee toignore the sounds or displayed objects, and focus only on selecting thecorrect colors or words in the boxes according to the instructions.

Turning now to FIG. 19, the examinee GUI for the color word inhibitiontask may display data similar to that in the client view of thenon-limiting example GUI in FIG. 19, and an examiner GUI may include aclient view display, and general and correct/incorrect responseinstructions, similar to those seen in FIG. 19, and as described above.As seen in FIG. 19, the word identification examinee GUI may include therows and boxes described above.

However, in FIG. 19, the examinee GUI for the top row box of the wordidentification task may not only include a text string forming a worddescribing a color, but may also: be displayed within a font color thesame as, or other than, the color described by the text string, asdescribed above; include a filled box, as described above; include avisual indicator (e.g., the outline or background for the box isyellow), possibly to indicate a switching task, as described above;include a filled box, with a color other than the text string formingthe word, or the color described by the text string, as described above;and/or be offset from the center to the left or the right, or possiblyincluding offsets within the box itself to the left or right, as seen inFIG. 19.

The multiple boxes in the lower row may each display a text stringforming a word describing a color, and one of these boxes may match atext string forming a word describing the font color of the text stringwithin the top row box. In some embodiments, the multiple boxes in thelower row may display text describing colors of additional elements,such as the color of the box, the color of the outline or background,the color filling the box, etc. The instructions may direct the examineeto select the word in one of the multiple boxes in the lower row thatmatches the font color of the text string forming the word (or othercolors) within the top row box.

The additional colors, as well as the left and right offsets within thetop row box, may act as distractors within the practice or actual tests.For example, FIG. 19 includes the top row box of the color wordinhibition task, which is offset to the left of the screen (i.e., notcentered within the GUI or relative to the multiple boxes in the lowerrow). The top row box is also offset to the left, and includes the textstring “RED.” As a non-limiting example, the text “RED” may be displayedin a blue font color, within a box filled with red, possibly with ahighlighted outline, etc. The multiple boxes in the lower row mayinclude a description of any of these colors and, according to theinstructions, the user may be instructed to select the matching text, orany of the matching colors in the top row box.

These distractions are unique from the trail making test and otherdistractions discussed above. They takes advantage of the human tendencyand inability to stop engaging in an overlearned behavior, despiteinstruction to the contrary. For example, a user that sees the word REDautomatically thinks red, even if the instructions have the user focuson the color blue (e.g., the background of the box, the font color ofthe word RED, etc., directing the user to focus on the actual word, orthe color of the word or background color, etc. according to whether thebox includes an outline (e.g., yellow outline)).

As noted above, an additional distraction may include movement of thebox around the screen. In some embodiments, rather than providing aresponse stimuli that always appears in the center of the GUI, where theuser's attention and focus are naturally focused, some embodiments maymove the top row box to the left or the right, requiring the user totrack the information in the box, thereby adding an additional level ofattentional regulation required by the user. This distraction also takesadvantage of the Simon effect, wherein people tend to respond to stimulithat appear within the same visual field or area. For example, if thestimulus appears in the left side of the GUI, the user will be morenaturally pulled to want to touch the response that's on the left sideof the GUI rather than the correct answer, which may be in the center oron the right side of the GUI. By moving the visual stimuli, the usermust inhibit the tendency to stay on the same side of the GUI.

This positional distractor may therefore provide an additional layer ofdistraction, regulating two different types of inhibitory control, sothat in FIG. 19, for example, if the instructions were for the user toselect the font color of the top row box (blue), the user would have atendency to select the box containing RED, since it has a common word,and is on the left side of the GUI, where the user's attention isnaturally focused. In addition, the background of each box may addanother layer of distraction.

The examinee may progress through the color word inhibition practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, if the instructions requirethe user to select the lower row box matching the font color, and thetop row box displays the word “red,” but is displayed in a blue font,and the examinee selects a box containing a word describing a colorother than the font color for the word within the top row box (e.g.,red, as shown in FIG. 19, or green), the error feedback may instruct theexaminee that the examinee should select the box including the wordmatching the font color of the word within the top row box (e.g., blue),and thus should have selected the box with blue rather than red orgreen. In this example, the examinee may try again starting with a newtop row box and new boxes on the lower row, or restart the previoustask.

The GUI and other parameters for the practice test and actual test forthe color word interference with distraction task may have any or allcharacteristics for color identification, word identification,inhibition, and/or switching tasks described above. However, during thepractice tests and actual tests, the examinee may be presented with anyof the distractors described above. The instructions may direct theexaminee to ignore these distractors, and focus only on selecting thecorrect colors or words in the boxes according to the instructions.

The examinee may repeat the practice test, and/or take additionalpractice tests, and after one or more practice tests, the examinee maytake the actual test and be scored as described above, according totheir selection of the correct box containing the word matching the fontcolor of the word in the first top row box.

The scoring rubric may directly compare the performance of the practiceor actual test with distractions to an identical task without thedistractions, in order to determine what the cost of distraction forthat examinee. The system may therefore anticipate examinees taking thepractice or actual test with and without the distractors in order togenerate a delta to determine the effect of distractors on the people.

The scoring rubric for the color word inhibition task with distractorsmay be incorporated into the scoring rubric generally. As noted above,the distractors may affect the time required to complete the taskswithin the instructions, which may, in turn, create a more focusedidentification of the reason for the cognitive decline following headtrauma or neurological insult, for example. Thus, a primary variable forscoring each of the tasks is the speed it takes an examinee to completeit. If this time increases significantly in the presence of adistraction, the examinee's likelihood that the user is easilydistracted is also increased.

The disclosed embodiments may also assess examinees who perform the testwell when there are no distractions, and compare this with distractionembodiments, do determine whether the examinees make errors when thereare distractions. In other words, in distraction embodiments, thedistractions may both slow down the user, and may cause them to make thewrong choice. For example, the user may make sequencing or switchingerrors as disclosed above, and the scoring rubric may be adjusted toconsider error rate and types of errors in scoring the examinee.

Additional responsive embodiments may be envisioned, wherein, as theuser performs better and better, additional increased difficulty fordistractions are introduced. For example, the user may begin with onlyaudio distractions, and as they continue to progress, visualdistractions may be introduced, or vice versa. In some embodiments, thetypes of distractors may be particularly distracting to a particulartype of person (e.g., person distracted by visual more than audiodistractors, for example).

Thus, the Color Word Interference subtest may evaluate executivefunction domains including Cognitive/Behavioral Control, InhibitoryControl, Self-Monitoring, and Rule Violations tests to determine thecognitive abilities of the examinee. Specifically, the coloridentification, word identification, and color word inhibition taskstrack the examinee's cognitive abilities to select the correct wordmatching the color, word, and/or font color of the top row box.

The Color Word Interference subtest also demonstrates the CognitiveFlexibility executive function domain. The input task data demonstratesmultiple simultaneous function skills to determine the cognitiveabilities of the examinee being used simultaneously. Specifically, thecolor word inhibition task tests the examinee's cognitive ability toselect the font color of the word in the top row box, rather than theword itself. The switching task tracks the examinee's cognitive abilityto switch while maintaining the ability to select the correct color orword according to the visual indicator (e.g., yellow outline orbackground). The color/word identification and/or switching task withdistraction tests the examinee's cognitive ability to ignoredistractions while maintaining the ability to select the correct word orcolor in combination with any of the disclosed tests.

Turning now to FIG. 13, the Tower subtest may evaluate executivefunction domains including Cognitive/Behavioral Control, Planning,Cognitive Flexibility (multiple simultaneous tasks), and RuleViolations. As seen in FIG. 13, the examinee GUI for the tower task maydisplay data similar to that in the non-limiting example GUI in FIG. 13,and an examiner GUI may include a client view display, and general andcorrect/incorrect response instructions, as described above. As seen inFIG. 13, the tower examinee GUI may include a combination of graphicsrepresenting pegs, and multiple rings (chips) to be stacked in order onthe pegs. The user may select each chip (e.g., by clicking and holding amouse, for example) to simulate lifting it off of the peg, andthereafter drop the chip onto the same or a different peg. Theinstructions may direct the examinee to move the chips on the bottom sothat they end up in the same order on the same peg as the chips on top,using as few moves as possible.

The examinee may progress through the tower practice test, where correctanswers are reinforced and incorrect answers are identified as disclosedabove. For example, if the examinee tries to move a chip incorrectly(e.g., tries to touch the floating chip; touches the lower part of thepeg; tries to move multiple chips; tries to move the chips on top;etc.), the error feedback may instruct the examinee that the examineethat these moves are incorrect. In this example, the examinee may tryagain starting with the chips in the previous or original position. Inanother example, if the instructions limit the examinee to a certainnumber of moves, and the examinee uses more than the allotted moves, theerror feedback may instruct the examinee to complete the tower in theallotted amount of moves or less. In this example, the examinee shouldtry again, possibly with a reset task. In another example, if theinstructions designate that a smaller chip should go on a larger one, orvice versa, and the examinee placed the incorrect chip on top ofanother, the error feedback may instruct the examinee to not placeincorrect sized chips on top of others. In this example, the examineeshould try again, possibly with a reset task. The examinee may repeatthe practice test, and/or take additional practice tests, and after oneor more practice tests, the examinee may take the actual test and bescored as described above, according to their ability to correctly movechips to build the tower.

Turning now to FIG. 14, the Social Sorting subtest may include, asnon-limiting examples, Category Sorting, and Emotion Sorting tasks, eachof which is described in detail below. The Social Sorting subtest mayevaluate executive function domains including Cognitive/BehavioralControl, Cognitive Flexibility (multiple simultaneous tasks),Self-Monitoring, and Emotion Regulation.

As seen in FIG. 14, the examinee GUI for the category sorting task maydisplay data similar to that in the non-limiting example GUI in FIG. 14,and an examiner GUI may include a client view display, and general andcorrect/incorrect response instructions, similar to those seen in FIG.14, and as described above. As seen in FIG. 14, the category sortingexaminee GUI may include 4 key cards at the top of the GUI screen, laidout from left to right in order. The category sorting examinee GUI mayfurther include a “deck” of displayed cards at the bottom of the screen.The instructions may direct the examinee to take the top card on thedeck and place it below the key card that the examinee thinks it matches(e.g., move the top card from the deck, and drag it below the key cardthe examinee thinks it matches, then unclick the mouse, for example). Insome embodiments, the instructions may not direct the examinee on how tomatch the cards, but may notify the examinee each time if the match isright or wrong. As non-limiting examples, the category matching examineeGUI may be testing similarities in person, clothes, etc.

The examinee may progress through the category sorting practice test,where correct answers are reinforced (e.g., the card flashes green) andincorrect answers (e.g., the card flashes red) are identified asdisclosed above. For example, if the examinee places the card under therow for an incorrect match, (e.g., person, clothes, or other categoriesdon't match), the error feedback may instruct the examinee that theexaminee has incorrectly matched the card showing on the deck, and thatthe card placed by the examinee does not match the key card in any ofthe correct ways (e.g., no matching categories). In this example, theinstructions may direct the examinee to leave the card and try to getthe next one correct, or may create an entirely new group of cards anddeck. In this example, the examinee should try again, possibly with areset group of keycards and deck. The examinee may repeat the practicetest, and/or take additional practice tests, and after one or morepractice tests, the examinee may take the actual test and be scored asdescribed above, according to their ability to correctly match cards inthe deck to the keycards displayed in a row.

Returning now to FIG. 14, the examinee GUI for the emotion sorting taskmay display data similar to that in the non-limiting example GUI in FIG.14, and an examiner GUI may include a client view display, and generaland correct/incorrect response instructions, similar to those seen inFIG. 14, and as described above. As above, the emotion sorting examineeGUI may include 4 key cards in a row and a deck of displayed cards, andthe instructions may direct the examinee to take the top card on thedeck and place it below the key card that the examinee thinks itmatches. As above, the instructions may not direct the examinee on howto match the cards, but may notify the examinee each time if the matchis right or wrong. As non-limiting examples, the emotion matchingexaminee GUI may be testing similarities in emotions, facialexpressions, etc.

The examinee may progress through the emotion sorting practice test,where correct answers are reinforced (e.g., the card flashes green) andincorrect answers (e.g., the card flashes red) are identified asdisclosed above. For example, if the examinee places the card under therow for an incorrect match, (e.g., emotion, facial expression, or otheremotional cues don't match), the error feedback may instruct theexaminee that the examinee has incorrectly matched the card showing onthe deck, and that the card placed by the examinee does not match thekey card in any of the correct ways (e.g., no matching emotions). Inthis example, the instructions may direct the examinee to leave the cardand try to get the next one correct, or the examinee should try again,possibly with a reset group of keycards and deck. The examinee mayrepeat the practice test, and/or take additional practice tests, andafter one or more practice tests, the examinee may take the actual testand be scored as described above, according to their ability tocorrectly match cards in the deck to the keycards displayed in a row.

Thus, the Social Sorting subtest may evaluate executive function domainsincluding Cognitive/Behavioral Control; Self-Monitoring; and EmotionRegulation to determine the cognitive abilities of the examinee.Specifically, the category sorting and emotion sorting tasks track theexaminee's cognitive abilities to select the correct match between thetop card on the deck and one of the cards in the row, according tocategory and emotion respectively.

The Social Sorting subtest also demonstrates the Cognitive Flexibilityexecutive function domain. The input task data demonstrates multiplesimultaneous function skills to determine the cognitive abilities of theexaminee being used simultaneously. Specifically, the category andemotion sorting tasks test the examinee's cognitive ability to recognizevarious means of sorting the cards and matching them accordingly.

Turning now to FIG. 15, the Derby subtest may evaluate executivefunction domains including Cognitive/Behavioral Control; Risk-TakingControl; and Emotion Regulation tests. As seen in FIG. 15, the examineeGUI for the derby task may display data similar to that in thenon-limiting example GUI in FIG. 15, and an examiner GUI may include aclient view display, and general and correct/incorrect responseinstructions, as described above. As seen in FIG. 15, the derby examineeGUI may include a combination of graphics representing moneydenominations, horses and jockeys, racing tracks, a finish line, and atotal amount of the examinee's money from the derby task. Theinstructions may direct the examinee to pretend that they have onethousand dollars to bet on horse races (or in some embodiments, frograces), and to try to win as much money as possible. In this task, thehorse closest to the finish line always pays less money if it wins,because it has a shorter distance to run. The horse farthest from thefinish line always pays the most, because it has longer to run. But, foreach race, any of the horses could win. The instructions may instructthe examinee to play as if it's really their money.

For each race, the examinee may be instructed that to pick a horse byselecting the five, fifty, or one-hundred dollar bet. If the examinee'shorse wins, the examinee wins the bet. If the examinee's horse finisheslast, the examinee loses the bet. If the examinee's horse finishessecond, the examinee doesn't win or lose any money. The instructions maydirect the examinee to place their bet quickly, as each race beginsafter a set time period (e.g., 10 seconds). After each race, theexaminee GUI displayed how much money the examinee has.

The examinee may progress through the derby practice test, where correctanswers are reinforced and incorrect answers are identified as disclosedabove. For example, if the examinee doesn't place a bet in time for therace, the error feedback may instruct the examinee that they failed toplace a bet in time for the race. In this example, the examinee may tryagain the first time without consequence, but in future races may losemoney each time this happens. The examinee may repeat the practice test,and/or take additional practice tests, and after one or more practicetests, the examinee may take the actual test and be scored as describedabove, according to their ability to correctly predict the winning horseand collect the money from the bet.

Turning now to FIG. 16, the Prosody Word Interference subtest mayinclude, as non-limiting examples, Prosody/Word Identification,Prosody/Emotion Naming, Inhibition, and Switching tasks, each of whichis described in detail below. The Social Sorting subtest may evaluateexecutive function domains including Cognitive/Behavioral Control,Cognitive Flexibility, (multiple simultaneous tasks), InhibitoryControl, and Emotion Regulation.

Returning now to FIG. 16, the examinee GUI for the prosody/wordidentification task may display data similar to that in the non-limitingexample GUI in FIG. 16, and an examiner GUI may include a client viewdisplay, and general and correct/incorrect response instructions, asdescribed above. As seen in FIG. 16, the prosody/word identificationexaminee GUI may include a series of boxes, each of which includes acharacter string forming a word describing an emotion (e.g., angry, sad,happy, etc.). The user interface may also include an audio file with avoice stating one of the emotions (e.g., “angry,” “sad,” “happy,” etc.).The instructions may direct the examinee to select the box that matchesthe word in the audio file, so if the examinee hears the word angry,sad, or happy, the examinee selects the matching box containing the wordangry, sad, or happy. In some embodiments, the instructions may directthe examinee to listen carefully, as the audio sample will only beplayed once.

The examinee may progress through the prosody/word identificationpractice test, where correct answers are reinforced and incorrectanswers are identified, possibly using visual feedback, and/or asdisclosed above. For example, if the word is happy, and the examineeselects the box containing the word angry, the error feedback mayinstruct the examinee that the examinee should select the word thatmatches the word in the audio sample. In this example, the examinee maytry again starting at the last audio sample, or may be provided with anew audio sample. The examinee may repeat the practice test, and/or takeadditional practice tests, and after one or more practice tests, theexaminee may take the actual test and be scored as described above,according to their selection of the correct box containing the wordstated in the audio sample.

Returning now to FIG. 16, the examinee GUI for the prosody/emotionnaming task may display data similar to that in the non-limiting exampleGUI in FIG. 16, and an examiner GUI may include a client view display,and general and correct/incorrect response instructions, as describedabove. As seen in FIG. 16, the prosody naming examinee GUI may include aseries of boxes as described above. The user interface may also includean audio file with a voice making a statement (e.g., “goodbye”) in acertain tone of voice. The instructions may direct the examinee toselect the box that matches the tone of voice, so if the examinee hearsa happy voice, the examinee would select the box containing the wordhappy. In some embodiments, the instructions may direct the examinee tolisten carefully, as the audio sample will only be played once.

The examinee may progress through the prosody/emotion naming practicetest, where correct answers are reinforced and incorrect answers areidentified, possibly using visual feedback, and/or as disclosed above.For example, if the tone of voice is angry and the examinee selects thebox containing the word happy, the error feedback may instruct theexaminee that the examinee should select the word that matches the toneof voice (e.g., angry). In this example, the examinee may try againstarting at the last audio sample, or may be provided with a new audiosample. The examinee may repeat the practice test, and/or takeadditional practice tests, and after one or more practice tests, theexaminee may take the actual test and be scored as described above,according to their selection of the correct tone of voice in the audiosample.

Returning now to FIG. 16, the examinee GUI for the prosody naminginhibition task may display data similar to that in the non-limitingexample GUI in FIG. 16, and an examiner GUI may include a client viewdisplay, and general and correct/incorrect response instructions, asdescribed above. As seen in FIG. 16, the prosody naming examinee GUI mayinclude a series of boxes as described above. The user interface mayalso include an audio file with a voice stating a word (e.g., angry,sad, or happy). However, for the inhibition task, the tone of voice forthe word may reflect a different emotion than the word itself (e.g., theword angry, said in a sad tone of voice). The instructions may directthe examinee to select the box that matches the tone of voice, not theword they hear, so in the example above, if the examinee hears a sadvoice saying the word angry, the examinee would select the boxcontaining the word sad. The converse may also be tested, where theexaminee selects the word spoken, and not the tone of voice. In someembodiments, the instructions may direct the examinee to listencarefully, as the audio sample will only be played once.

The examinee may progress through the inhibition practice test, wherecorrect answers are reinforced and incorrect answers are identified,possibly using visual feedback, and/or as disclosed above. For example,if the tone of voice is sad and the examinee selects the box containingthe word angry, the error feedback may instruct the examinee that theexaminee should select the word that matches the voice (e.g., sad), andnot the word spoken in the audio sample (e.g., angry). The converse mayalso be true. In this example, the examinee may try again starting atthe last audio sample, or may be provided with a new audio sample. Theexaminee may repeat the practice test, and/or take additional practicetests, and after one or more practice tests, the examinee may take theactual test and be scored as described above, according to theirselection of the correct tone of voice, and not the spoken word, or viceversa, according to the instructions.

The GUI and other parameters for the practice test and actual test forthe prosody switching task may have any or all characteristics describedabove for the prosody/word identification, the prosody/emotion naming,and/or the prosody inhibition tasks described above. However, inaddition to directing the examinee to select the correct box containingthe word or emotion in the series of boxes, the instructions may furtherdirect the examinee that if a box in the series of boxes includes avisual indicator (e.g., the outline or background for the box isyellow), to select either a box that matches the word in the audiosample, or to select the box that matches the emotion reflected in theaudio sample, thereby switching between identifying words andidentifying emotions according to the instructions.

The examinee may progress through the word/emotion switching practicetest, where correct answers are reinforced and incorrect answers areidentified as disclosed above. For example, in addition to the errorfeedback provided in the prosody/word identification, prosody/emotionnaming, and word/emotion task inhibition examples above, if the examineeselects a word matching the word in the audio sample, because of theyellow outline around or background within the box, when they shouldhave selected the word describing the emotion in the audio sample, orvice versa, according to the instructions, the error feedback mayinstruct the examinee that the examinee should switch when the yellowoutline is around, or background is within, the box, according to theinstructions. In this example, the examinee should try again starting atthe last correct word or emotion match selection, or possibly creating anew examinee GUI. The examinee may repeat the practice test, and/or takeadditional practice tests, and after one or more practice tests, theexaminee may take the actual test and be scored as described above,according to their selection of correct matches to words and emotions,based on the visual indicator and the instructions.

Thus, the Prosody Word Interference subtest may evaluate executivefunction domains including Cognitive/Behavioral Control, InhibitoryControl, and Emotion Regulation to determine the cognitive abilities ofthe examinee. Specifically, the word identification, emotion naming, andinhibition tasks track the examinee's cognitive abilities to select thecorrect word matching the word or emotion of the audio sample.

The Prosody Word Interference subtest also demonstrates the CognitiveFlexibility executive function domain. The input task data demonstratesmultiple simultaneous function skills to determine the cognitiveabilities of the examinee being used simultaneously. Specifically, theinhibition task tests the examinee's cognitive ability to select theemotion in the voice of the audio sample, rather than the word itself(or vice versa). The switching task tracks the examinee's cognitiveability to switch while maintaining the ability to select the correctemotion or word according to the visual indicator (e.g., yellow outlineor background) and instructions.

Turning now to FIG. 17, the Grocery List subtest evaluates executivefunction domains including Cognitive/Behavioral Control, Planning,Inhibitory Control, and Rule Violations. As seen in FIG. 17, theexaminee GUI for the grocery list task may display data similar to thatin the non-limiting example GUI in FIG. 17, and an examiner GUI mayinclude a client view display, and general and correct/incorrectresponse instructions, as described above. As seen in FIG. 17, thegrocery list examinee GUI may include a series of graphicalrepresentations of: a grocery cart, a checkout register, and a series ofshelves, aisles, and various grocery products, as well as a shoppinglist displayed at the top of the screen representing the groceryproducts to be collected. The instructions may direct the examinee thatthe GUI displays a virtual grocery store with shelves and aisles, andthat the user should draw a line to select the grocery items displayedat the top of the screen using the shortest path from the basket to thecheckout register graphic without reentering any of the displayedaisles.

The instructions may further instruct the examinee regarding rules: thatthe examinee must start with the grocery cart; that the examinee mustmove in a single continuous line (which the shopping cart graphic mayfollow as created); that if the examinee stops and changes position ofthe input that the examinee must return to the previously drawn line tocontinue; that the examinee must not draw a path through a shelf; etc.In some embodiments, the examinee must select at least one of a type ofgrocery item (e.g., fruit).

The examinee may progress through the grocery list practice test, wherecorrect answers are reinforced and incorrect answers are identified asdisclosed above. For example, if the examinee reenters an aisle, theerror feedback may instruct the examinee that the examinee should onlyenter each aisle once. If the examinee doesn't take the shortest path,the error feedback may instruct the examinee to take the shortest path,and possibly demonstrate such a path. If the examinee doesn't includethe at least one type of grocery item, the error feedback may instructthe examinee to select such an item. In these examples, the examinee maytry again starting at the beginning or from their last correct position.The examinee may repeat the practice test, and/or take additionalpractice tests, and after one or more practice tests, the examinee maytake the actual test and be scored as described above, according totheir selection of the grocery items according to the instructions.

Other embodiments and uses of the above inventions will be apparent tothose having ordinary skill in the art upon consideration of thespecification and practice of the invention disclosed herein. Thespecification and examples given should be considered exemplary only,and it is contemplated that the appended claims will cover any othersuch embodiments or modifications as fall within the true scope of theinvention.

The Abstract accompanying this specification is provided to enable theUnited States Patent and Trademark Office and the public generally todetermine quickly from a cursory inspection the nature and gist of thetechnical disclosure and in no way intended for defining, determining,or limiting the present invention or any of its embodiments.

The invention claimed is:
 1. A system comprising a server hardwarecomputing device coupled to a network and comprising at least oneprocessor executing specific computer-executable instructions within amemory that, when executed, cause the system to: generate: a firstseries of user interface objects selected from a database coupled to anetwork, and comprising: a first sequence including a plurality ofletters; or a plurality of character string descriptions, each characterstring in the plurality of character strings comprising a colorcharacter string or a user interface characteristic character string; asecond series of user interface objects selected from the database andcomprising: a second sequence including a plurality of numbers; or aplurality of user interface characteristics including a color or acharacteristic of a user interface object in the first series of userinterface objects or the second series of user interface objects; athird series of user interface objects comprising a plurality of visualor audio distractors designed to pull the attention of a user from thefirst series of user interface objects or the second series of userinterface objects; at least one visual indicator display object selectedfrom the database and requiring, according to a logic or at least onerule within the specific computer-executable instructions, a switch,alternating between the first series of user interface objects, and thesecond series of user interface objects; encode, for display on a clienthardware computing device comprising an examinee client device or anexaminer client device, a graphical user interface (GUI) comprising thefirst series of user interface objects, the second series of userinterface objects, the third series of user interface objects, and theat least one visual indicator display object; decode, from the GUI, anelectronic input from the user switching from the first series of userinterface objects, displayed in association with the visual indicatordisplay object, to the second series of user interface objects;responsive to the electronic input failing to match a correct responseassociated in the database with a task data defining a function skilldemonstrating a cognitive ability of a user, calculate a score; pauseadditional input into the GUI; update a content within the GUI toinclude: an identification of the electronic input as incorrect; avisual cue for the electronic input failing to match the correctresponse; and a last correct input from which to continue; transmit areal-time rendering of the GUI and the electronic input to the examinerclient device for display on an examiner GUI; display, on the examinerGUI an instruction for how to proceed; and compare the score with aprevious score for a task not including the third series of userinterface objects.
 2. The system of claim 1, wherein-the GUI displayedon the examiner client device includes: an electronic output providingthe user with instructions for providing the electronic input; a firstGUI control for monitoring the electronic input received from the user;or a second GUI control for demonstrating a correct response and anincorrect response by the user.
 3. The system of claim 1, wherein theelectronic input comprises a selection by the user, via a touch screen,a stylus, or an electronic mouse, of each element within the firstsequence or the second sequence, and wherein the GUI does not display anorder of the selection of each element.
 4. The system of claim 3,wherein a second task associated with the second series of userinterface objects requires a greater interactivity by the user than afirst task associated with the first series of user interface objects,and a third task requires a greater interactivity by the user than thesecond task.
 5. The system of claim 3, wherein: the first series of userinterface objects includes the plurality of letters; the second seriesof user interface objects includes the plurality of numbers; the thirdseries of user interface objects includes a plurality of letters ornumbers visually distinct from the first series of user interfaceobjects or the second series of user interface objects; a first userinput decoded by the server hardware computing device comprises thefirst user input selecting, alternatively, the plurality of letters andthe plurality of numbers; a second user input decoded by the serverhardware computing device comprises the second user input following aselection of a first number including the at least one visual indicatorwith a second number, or, following a selection of a first letterincluding the at least one visual indicator with a second letter; and athird user input decoded by the server hardware computing devicecomprises the third user input moving sequentially between the firstseries of user interface objects or the second series of user interfaceobjects without a visual reminder, displayed on the GUI, indicating apreviously selected letter or number.
 6. The system of claim 5, whereineach of the third series of user interface objects is displayed on theGUI in close proximity to at least one of the first series or the secondseries of user interface objects displaying an identical letter ornumeric value.
 7. The system of claim 6, wherein each of the firstseries and the second series of user interface objects are enclosedwithin a circle and, each of the third series of user interface objectsis not enclosed within a circle.
 8. The system of claim 1, wherein: theGUI displays a plurality of character strings, each character stringrepresenting the color, and each character string being displayed in afont color; a first user input decoded by the server hardware computingdevice comprises the first user input selecting a character string fromthe plurality of character strings matching a second character string; asecond user input decoded by the server hardware computing devicecomprises the second user input selecting a character string from theplurality of character strings wherein the font color matches a colordescribed by the second character string; and a third user input decodedby the server hardware computing device comprises a visual cue, wherein,if the visual clue is displayed on the GUI the third user input selectsthe character string matching the second character string, but if thevisual clue is not displayed on the GUI, the third user input selectsthe font color matching the second character string.
 9. The system ofclaim 8, wherein the first series of user interface objects is visuallyoffset from, or contains a different background color from, the secondseries of user interface objects.
 10. A method comprising: generating,by a server hardware computing device coupled to a network andcomprising at least one processor executing specific computer-executableinstructions within a memory: a first series of user interface objectsselected from a database coupled to a network, and comprising: a firstsequence including a plurality of letters; or a plurality of characterstring descriptions, each character string in the plurality of characterstrings comprising a color character string or a user interfacecharacteristic character string; a second series of user interfaceobjects selected from the database and comprising: a second sequenceincluding a plurality of numbers; or a plurality of user interfacecharacteristics including a color or a characteristic of a userinterface object in the first series of user interface objects or thesecond series of user interface objects; a third series of userinterface objects comprising a plurality of visual or audio distractorsdesigned to pull the attention of a user from the first series of userinterface objects or the second series of user interface objects; atleast one visual indicator display object selected from the database andrequiring, according to a logic or at least one rule within the specificcomputer-executable instructions, a switch, alternating between thefirst series of user interface objects, and the second series of userinterface objects; encoding, by the server hardware computing device,for display on a client hardware computing device comprising an examineeclient device or an examiner client device, a graphical user interface(GUI) comprising the first series of user interface objects, the secondseries of user interface objects, the third series of user interfaceobjects, and the at least one visual indicator display object; decoding,by the server hardware computing device, from the GUI, an electronicinput from the user switching from the first series of user interfaceobjects, displayed in association with the visual indicator displayobject, to the second series of user interface objects; responsive tothe electronic input failing to match a correct response associated inthe database with a task data defining a function skill demonstrating acognitive ability of a user, calculate a score: pausing additional inputinto the GUI; updating a content within the GUI to include: anidentification of the electronic input as incorrect; a visual cue forthe electronic input failing to match the correct response; and a lastcorrect input from which to continue; transmitting a real-time renderingof the GUI and the electronic input to the examiner client device fordisplay on an examiner GUI; and displaying, on the examiner GUI aninstruction for how to proceed; and comparing, by the server hardwarecomputing device, the score with a previous score for a task notincluding the third series of user interface objects.
 11. The method ofclaim 10, wherein-the GUI displayed on the examiner client deviceincludes: an electronic output providing the user with instructions forproviding the electronic input; a first GUI control for monitoring theelectronic input received from the user; or a second GUI control fordemonstrating a correct response and an incorrect response by the user.12. The method of claim 10, wherein the electronic input comprises aselection by the user, via a touch screen, a stylus, or an electronicmouse, of each element within the first sequence or the second sequence,and wherein the GUI does not display an order of the selection of eachelement.
 13. The method of claim 12, wherein a second task associatedwith the second series of user interface objects requires a greaterinteractivity by the user than a first task associated with the firstseries of user interface objects, and a third task requires a greaterinteractivity by the user than the second task.
 14. The method of claim12, wherein: the first series of user interface objects includes theplurality of letters; the second series of user interface objectsincludes the plurality of numbers; the third series of user interfaceobjects includes a plurality of letters or numbers visually distinctfrom the first series of user interface objects or the second series ofuser interface objects; a first user input decoded by the serverhardware computing device comprises the first user input selecting,alternatively, the plurality of letters and the plurality of numbers; asecond user input decoded by the server hardware computing devicecomprises the second user input following a selection of a first numberincluding the at least one visual indicator with a second number, or,following a selection of a first letter including the at least onevisual indicator with a second letter; and a third user input decoded bythe server hardware computing device comprises the third user inputmoving sequentially between the first series of user interface objectsor the second series of user interface objects without a visualreminder, displayed on the GUI, indicating a previously selected letteror number.
 15. The method of claim 14, wherein each of the third seriesof user interface objects is displayed on the GUI in close proximity toat least one of the first series or the second series of user interfaceobjects displaying an identical letter or numeric value.
 16. The methodof claim 15, wherein each of the first series and the second series ofuser interface objects are enclosed within a circle and, each of thethird series of user interface objects is not enclosed within a circle.17. The method of claim 10, wherein: the GUI displays a plurality ofcharacter strings, each character string representing the color, andeach character string being displayed in a font color; a first userinput decoded by the server hardware computing device comprises thefirst user input selecting a character string from the plurality ofcharacter strings matching a second character string; a second userinput decoded by the server hardware computing device comprises thesecond user input selecting a character string from the plurality ofcharacter strings wherein the font color matches a color described bythe second character string; and a third user input decoded by theserver hardware computing device comprises a visual cue, wherein, if thevisual clue is displayed on the GUI the third user input selects thecharacter string matching the second character string, but if the visualclue is not displayed on the GUI, the third user input selects the fontcolor matching the second character string.
 18. The method of claim 17,wherein the first series of user interface objects is visually offsetfrom, or contains a different background color from, the second seriesof user interface objects.